The effects of an attentional demand tasks on standing posture control

The present study sought to determine if the postural sway of a subject required to grasp a tray (motor task) holding a cup filled with water and prevent spilling (mental task), would be reduced by consciously redirecting attention to maintain the tray in a horizontal position. We hypothesized the mental task would increase the stabilization of standing postural balance. Postural sway was measured in 17 normal subjects under the following conditions: 1) holding a 100 g weight in each hand (total 200 g; no mental task), 2) holding with both hands a tray on which 200 g was placed (tray-holding task), and 3) holding with both hands a tray on which a cup filled with water weighing 200 g was placed in the center (mental task). Postural sway was significantly reduced during the mental task versus other tasks. Standing posture balance was stabilized when a mental task was added. Thus, we concluded that higher brain functions such as attention and consciousness exerted a significant influence over the control of standing posture.     

Characteristic Features of Disorders of the Upright Posture in Patients with Poststroke Hemipareses

Characteristic features of upright posture maintenance and mechanisms of postural disorders in poststroke hemiparetic patients were studied using a bilateral force platform. The following features of postural disorders were revealed in the patients tested: an increase in the velocity and amplitude of the center-of-pressure (CP) sway as compared to in healthy subjects, an absolute decrease in the half-cycles of the CP sway, asymmetry of weight bearing by both feet, and a shift of the center of pressure of an affected foot towards the toe. The disturbance of stability of the vertical posture in such patients is to a greater extent associated with weight-bearing asymmetry. It was shown that the character of the CP sway is mainly determined by a disorder of the sensory motor control, whereas damage to the efferent pathways is responsible for the postural asymmetry. Increase in the muscle tone restricts the sway amplitude. Thus, several forms of postural instability are characteristic of hemiparetic patients. Predominantly sensory, motor, or tonic disorders are responsible for these disturbances of stability.     

Spherical Lenses and Prisms Lead to Postural Instability in Both Dyslexic and Non Dyslexic Adolescents

There is controversy as to whether dyslexic children present systematic postural deficiency. Clinicians use a combination of ophthalmic prisms and proprioceptive soles to improve postural performances. This study examines the effects of convergent prisms and spherical lenses on posture. Fourteen dyslexics (13–17 years-old) and 11 non dyslexics (13–16 years-old) participated in the study. Quiet stance posturography was performed with the TechnoConcept device while subjects fixated a target at eye-level from a distance of 1_m. Four conditions were run: normal viewing; viewing the target with spherical lenses of −1 diopter (ACCOM1) over each eye; viewing with −3 diopters over each eye (ACCOM3); viewing with a convergent prism of 8 diopters per eye. Relative to normal viewing, the −1 lenses increased the surface of body sway significantly whereas the −3 diopter lenses only resulted in a significant increase of antero-posterior body sway. Thus, adolescents would appear to cope more effectively with stronger conflicts rather than subtle ones. The prism condition resulted in a significant increase in both the surface and the antero-posterior body sway. Importantly, all of these effects were similar for the two groups. Wavelet analysis (time frequency domain) revealed high spectral power of antero-posterior sway for the prism condition in both groups. In the ACCOM3 condition, the spectral power of antero-posterior sway decreased for non dyslexics but increased for dyslexics suggesting that dyslexics encounter more difficulty with accommodation. The cancelling time for medium range frequency (believed to be controlled by the cerebellum), was shorter in dyslexics, suggesting fewer instances of optimal control. We conclude that dyslexics achieve similar postural performances albeit less efficiently. Prisms and lenses destabilize posture for all teenagers. Thus, contrary to adults, adolescents do not seem to use efferent, proprioceptive ocular motor signals to improve their posture, at least not immediately when confronted to convergence accommodation conflict.     

Stance stability with unilateral and bilateral light touch of an external stationary object

Unilateral light fingertip touch of a stationary object has a significant stabilizing effect on postural sway during stance. The purpose of this study was to find out if this effect is enhanced by bilateral light touch of parallel stationary objects. The postural sway of 54 healthy subjects was tested in four stance conditions: no touch; unilateral left light touch of the left handle of a walker; unilateral right light touch of the right handle of the same walker; and bilateral light touch of the two handles. During testing, subjects stood blindfolded on two foam pads placed on the left and right force plates of the Tetrax balance system. Testing in each condition lasted 45 s and was executed twice in a random order. As expected, postural sway was significantly reduced by unilateral left or right light fingertip touch. It was significantly further decreased by bilateral light touch. In addition, light touch conditions were associated with a reduction in pressure fluctuations between the heel and forefoot of the same foot as well as those of the contralateral foot, with a concomitant increase in weight shift fluctuations between the two feet. The decrease in postural sway with bilateral light touch suggests cortical modulation of the bilateral touch inputs, with enhancement of the stabilizing response.     

Analysis of short- and long-term effects of adaptation in human postural control

 The short-term (i.e., days) and long-term (i.e., months) effects of adaptation to posturography examinations were investigated in 12 normal subjects who were repeatedly examined for five consecutive days and again after 90 days. The examinations were conducted both with eyes open and closed, and the perturbations were evoked by a pseudorandomly applied vibration stimulation to the calf muscles. The evoked anteroposterior responses were analyzed with a method considering adaptation in the slow changes in posture and in the stimulus–response relationship. Repetition of examinations on a daily basis revealed a gradual improvement of postural-control performance. The body sway induced by the stimulation was significantly reduced and the dynamical properties changed. Most of the improvements remained after 90 days, but some parameters such as the complexity of the control system used were increased to the initial level. The results confirm previous observations that postural control contains several partially independent adaptive processes, observed in terms of alteration of posture and as a progressive reduction of body sway induced by stimulation. The method used for the adaptation analysis in this study could be applied to analyze biological systems with multiple individual adaptive processes with different time courses or characteristics, or where the adaptation processes are related to multiple internal or external factors. Received: 2 January 2001 / Accepted in revised form: 27 November 2001     

Enhancing human balance control with galvanic vestibular stimulation

 With galvanic vestibular stimulation (GVS), electrical current is delivered transcutaneously to the vestibular afferents through electrodes placed over the mastoid bones. This serves to modulate the continuous firing levels of the vestibular afferents, and causes a standing subject to lean in different directions depending on the polarity of the current. Our objective in this study was to test the hypothesis that the sway response elicited by GVS can be used to reduce the postural sway resulting from a mechanical perturbation. Nine subjects were tested for their postural responses to both galvanic stimuli and support-surface translations. Transfer-function models were fit to these responses and used to calculate a galvanic stimulus that would act to counteract sway induced by a support-surface translation. The subjects' responses to support-surface translations, without and with the stabilizing galvanic stimulus, were then measured. With the stabilizing galvanic stimulus, all subjects showed significant reductions in both sway amplitude and sway latency. Thus, with GVS, subjects maintained a more erect stance and followed the support-surface displacement more closely. These findings suggest that GVS could possibly form the basis for a vestibular prosthesis by providing a means through which an individual's posture can be systematically controlled. Received: 11 May 2000 / Accepted in revised form: 20 November 2000     

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.     

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%).     

Stance stability with unilateral and bilateral light touch of an external stationary object

Unilateral light fingertip touch of a stationary object has a significant stabilizing effect on postural sway during stance. The purpose of this study was to find out if this effect is enhanced by bilateral light touch of parallel stationary objects. The postural sway of 54 healthy subjects was tested in four stance conditions: no touch; unilateral left light touch of the left handle of a walker; unilateral right light touch of the right handle of the same walker; and bilateral light touch of the two handles. During testing, subjects stood blindfolded on two foam pads placed on the left and right force plates of the Tetrax balance system. Testing in each condition lasted 45?s and was executed twice in a random order. As expected, postural sway was significantly reduced by unilateral left or right light fingertip touch. It was significantly further decreased by bilateral light touch. In addition, light touch conditions were associated with a reduction in pressure fluctuations between the heel and forefoot of the same foot as well as those of the contralateral foot, with a concomitant increase in weight shift fluctuations between the two feet. The decrease in postural sway with bilateral light touch suggests cortical modulation of the bilateral touch inputs, with enhancement of the stabilizing response.     

Chaos in Balance: Non-Linear Measures of Postural Control Predict Individual Variations in Visual Illusions of Motion

Visually-induced illusions of self-motion (vection) can be compelling for some people, but they are subject to large individual variations in strength. Do these variations depend, at least in part, on the extent to which people rely on vision to maintain their postural stability? We investigated by comparing physical posture measures to subjective vection ratings. Using a Bertec balance plate in a brightly-lit room, we measured 13 participants'' excursions of the centre of foot pressure (CoP) over a 60-second period with eyes open and with eyes closed during quiet stance. Subsequently, we collected vection strength ratings for large optic flow displays while seated, using both verbal ratings and online throttle measures. We also collected measures of postural sway (changes in anterior-posterior CoP) in response to the same visual motion stimuli while standing on the plate. The magnitude of standing sway in response to expanding optic flow (in comparison to blank fixation periods) was predictive of both verbal and throttle measures for seated vection. In addition, the ratio between eyes-open and eyes-closed CoP excursions during quiet stance (using the area of postural sway) significantly predicted seated vection for both measures. Interestingly, these relationships were weaker for contracting optic flow displays, though these produced both stronger vection and more sway. Next we used a non-linear analysis (recurrence quantification analysis, RQA) of the fluctuations in anterior-posterior position during quiet stance (both with eyes closed and eyes open); this was a much stronger predictor of seated vection for both expanding and contracting stimuli. Given the complex multisensory integration involved in postural control, our study adds to the growing evidence that non-linear measures drawn from complexity theory may provide a more informative measure of postural sway than the conventional linear measures.     

Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study

This longitudinal study aimed to compare static postural stability in women between early pregnancy, advanced pregnancy, and at 2 and 6 months postpartum. Forty-five pregnant women were enrolled and 31 completed the protocol. Data were collected at 7–16 and 34–39 weeks gestation, and at 6–10 and 26–30 weeks postpartum. For each subject, the center of foot pressure path length and mean velocity (with directional subcomponents) were computed from 30-s long quiet-standing trials on a stationary force plate with eyes open or closed. The body mass, stance width, and sleep duration within 24 h before testing were also recorded. Static postural stability was not different between pregnancy and postpartum, except for the anterior posterior sway tested in the eyes-closed condition, which was significantly increased in late pregnancy compared to that at 2 and 6 months postpartum. Pregnant/postpartum women’s body mass weakly positively correlated with anterior-posterior sway in the eyes-closed condition and their stance width weakly positively correlated with the anterior-posterior sway in the eyes-open condition. No effect of sleep duration on postural sway was found. Our findings indicate that under visual deprivation conditions women in advanced pregnancy may have decreased static stability compared to their non-pregnant state.     

Postural control during the Stroop test in dyslexic and non dyslexic teenagers

Postural control in quiet stance although simple still requires some cognitive resources; dual cognitive tasks influence further postural control. The present study examines whether or not dyslexic teenagers experience postural instability when performing a Stroop dual task for which their performances are known to be poor. Fifteen dyslexics and twelve non-dyslexics (14 to 17 years old) were recruited from the same school. They were asked to perform three tasks: (1) fixate a target, (2) perform an interference Stroop test (naming the colour or the word rather than reading the word), (3) performing flexibility Stroop task: the subject performed the interference task as in (2) except when the word was in a box, in which case he had to read the word. Postural performances were measured with a force platform. The results showed a main task effect on the variance of speed of body sway only: such variance was higher in the flexibility task than for the other two tasks. No group effect was found for any of the parameters of posture (surface, mediolateral and anteroposterior sway, variance of speed). Further wavelet analysis in the time-frequency domain revealed an increase in the spectral power of the medium frequency range believed to be related to cerebellum control; an accompanying increase in the cancellation time of the high frequency band related to reflexive loops occurred for non-dyslexics only. These effects occurred for the flexibility task and could be due to its high cognitive difficulty. Dyslexics displayed shorter cancellation time for the medium frequency band for all tasks, suggesting less efficient cerebellar control, perhaps of eye fixation and attention influencing body sway. We conclude that there is no evidence for a primary posture deficit in 15 year old teenagers who come from the general population and who were recruited in schools.     

Effects of excessive body weight on postural control

Research that evaluated both static and dynamic stability was performed, to clarify the impact of excessive body weight on postural control. The spontaneous center of foot pressure (CP) motion during quiet stance and a range of forward voluntary CP displacements were studied in 100 obese, and 33 lean women. Characteristics of postural sway were acquired while the subjects were standing quiet on a force plate with eyes open (EO) and with eyes closed (EC). Their anterior range of CP voluntary displacements was assessed upon a range of maximal whole body leanings which were directed forward. A substantial reduction of postural sway was observed in all patients which had increased body weight. Main postural sway parameters i.e., the total path length as well as its directional components were negatively correlated with the body mass and body mass index (BMI). The range of a whole body voluntary forward leaning, did not exhibit any significant change in patients with an obesity grade of I and II. Such a deficit was, however, found in subjects with a body mass index above 40. In conclusion, the increased body weight imposed new biomechanical constraints, that resulted in functional adaptation of the control of the erect posture. This functional adaptation was characterized by a reduced postural sway associated with a substantial reduction of the dynamic stability range in subjects with BMI>40.     

Postural control in bipolar disorder: increased sway area and decreased dynamical complexity

Structural, neurochemical, and functional abnormalities have been identified in the brains of individuals with bipolar disorder, including in key brain structures implicated in postural control, i.e. the cerebellum, brainstem, and basal ganglia. Given these findings, we tested the hypothesis that postural control deficits are present in individuals with bipolar disorder. Sixteen participants with bipolar disorder (BD) and 16 age-matched non-psychiatric healthy controls were asked to stand as still as possible on a force platform for 2 minutes under 4 conditions: (1) eyes open-open base; (2) eyes closed-open base; (3) eyes open-closed base; and (4) eyes closed-closed base. Postural sway data were submitted to conventional quantitative analyses of the magnitude of sway area using the center of pressure measurement. In addition, data were submitted to detrended fluctuation analysis, a nonlinear dynamical systems analytic technique that measures complexity of a time-series, on both the anterior-posterior and medio-lateral directions. The bipolar disorder group had increased sway area, indicative of reduced postural control. Decreased complexity in the medio-lateral direction was also observed for the bipolar disorder group, suggesting both a reduction in dynamic range available to them for postural control, and that their postural corrections were primarily dominated by longer time-scales. On both of these measures, significant interactions between diagnostic group and visual condition were also observed, suggesting that the BD participants were impaired in their ability to make corrections to their sway pattern when no visual information was available. Greater sway magnitude and reduced complexity suggest that individuals with bipolar disorder have deficits in sensorimotor integration and a reduced range of timescales available on which to make postural corrections.     

Effect of ageing and vision on limb load asymmetry during quiet stance

Although the identification and characterization of limb load asymmetries during quiet standing has not received much research attention, they may greatly extend our understanding of the upright stance stability control. It seems that the limb load asymmetry factor may serve as a veridical measure of postural stability and thus it can be used for early diagnostic of the age-related decline in balance control. The effects of ageing and of vision on limb load asymmetry (LLA) during quiet stance were studied in 43 healthy subjects (22 elderly, mean age 72.3+/-4.0 yr, and 21 young, mean age 23.9+/-4.8 yr). Postural sway and body weight distribution were recorded while the subject was standing on two adjacent force platforms during two 120 s trials: one trial was performed with the eyes open (EO), while the other trial was with the eyes closed (EC). The results indicate that LLA was greater in the old adults when compared with the young control subjects. The LLA values were correlated with the postural sway magnitudes especially in the anteroposterior direction. Eyes closure which destabilized posture resulted in a significant increase of body weight distribution asymmetry in the elderly but not in the young persons. The limb load difference between EO and EC conditions showed a significantly greater effect of vision on LLA in the elderly compared to the young subjects. The observed differences in the LLA may be attributed to the decline of postural stability control in the elderly. Ageing results in the progressive decline of postural control and usually the nervous system requires more time to complete a balance recovery action. To compensate for such a deficiency, different compensatory strategies are developed. One of them, as evidenced in our study, is preparatory limb unload strategy (a stance asymmetry strategy) which could significantly shorten reaction time in balance recovery.     

Functional muscle synergies constrain force production during postural tasks

We recently demonstrated that a set of five functional muscle synergies were sufficient to characterize both hindlimb muscle activity and active forces during automatic postural responses in cats standing at multiple postural configurations. This characterization depended critically upon the assumption that the endpoint force vector (synergy force vector) produced by the activation of each muscle synergy rotated with the limb axis as the hindlimb posture varied in the sagittal plane. Here, we used a detailed, 3D static model of the hindlimb to confirm that this assumption is biomechanically plausible: as we varied the model posture, simulated synergy force vectors rotated monotonically with the limb axis in the parasagittal plane (r2=0.94+/-0.08). We then tested whether a neural strategy of using these five functional muscle synergies provides the same force-generating capability as controlling each of the 31 muscles individually. We compared feasible force sets (FFSs) from the model with and without a muscle synergy organization. FFS volumes were significantly reduced with the muscle synergy organization (F=1556.01, p<0.01), and as posture varied, the synergy-limited FFSs changed in shape, consistent with changes in experimentally measured active forces. In contrast, nominal FFS shapes were invariant with posture, reinforcing prior findings that postural forces cannot be predicted by hindlimb biomechanics alone. We propose that an internal model for postural force generation may coordinate functional muscle synergies that are invariant in intrinsic limb coordinates, and this reduced-dimension control scheme reduces the set of forces available for postural control.     

Sinusoidal galvanic stimulation of the labyrinths and postural responses

We studied the effect of sinusoidal stimulation of the labyrinths on postural reflexes in man, using a 0.3 Hz current of alternating polarity and +/- 1 mA intensity for stimulation. The test subjects were tested binaurally by the bipolar method (BB), with two electrodes on the mastoid processes, and binaurally by the monopolar method (BM), with electrodes localized bilaterally on the mastoid process and the hand. Stabilographic postural parameters were measured in 22 subjects in five experimental situations. Each situation lasted 60 s. Body sway, detected by astabilometer, was recorded on a Philips FM tape-recorder and then analysed off-line on a PDP-11/34 computer. On BB stimulation of the labyrinths, the variance of body sway in the left-right (LR) direction increased more than in the anteroposterior (AP) direction. In BM stimulation, only the variance of LR sway increased. Other posturographic parameters displayed a similar effect. From the aspect of body sway frequency, BB stimulation produced a peak in the course of the power spectral density of the lateral stabilogram at 0.3 Hz. In this experimental situation, a habituation effect was manifested, depending on the subject. It can be stated that binaural bipolar (BB) stimulation of the labyrinths selectively influences lateral body sway, while the increase in AP body sway in this situation is merely a concomitant phenomenon.     

The relation between the changes of postural achievement, lower limb muscle activities, and balance stability in three different deep-squatting postures

Deep squatting places a burden on the lower limb muscles and influences postural balance. We attempted to determine the effects of postural changes on the rectus femoris, tibialis anterior, gastrocnemius, soleus, and extensor digitorum brevis muscles during squatting in 8 healthy male subjects. Three squatting conditions were involved: full squatting (FS), tiptoe squatting (TT), and tiptoe squatting on a 15 degrees slope (TTS), performed randomly and recorded in a period of 4 min for each task. The influence of the squatting condition on electromyography and vertical ground reaction force parameters was examined in order to observe the effect of postural alteration on muscle activity and balance control. The results showed that the change of squatting posture from FS to TT decreased the activity of the rectus femoris and tibialis anterior muscles. FS has been suspected as a main cause of musculoskeletal complaint during prolonged squatting. In contrast, as the heel was lifted, the extensor digitorum brevis muscle increased to 39% of maximum activation. On the other hand, sway analysis at TT showed balance instability regarding the large area occupation of the center of pressure displacement. The presence of a 15 degrees slope significantly reduced the muscular load. This simple study suggests that the inclusion of a sloping surface in daily activities that requires a squatting posture would be an effective means to reduce muscular load.     

Postural Stability in Young Adults with Down Syndrome in Challenging Conditions

To evaluate postural control and performance in subjects with Down syndrome (SwDS), we measured postural sway (COP) in quiet stance in four 20-second tests: with eyes open or closed and on hard or foam surface. Ten SwDS and eleven healthy subjects participated, aged 29.8 (4.8) and 28.4 (3.9), respectively. The time-series recorded with the sampling rate of 100 Hz were used to evaluate postural performance (COP amplitude and mean velocity) and strategies (COP frequency, fractal dimension and entropy). There were no intergroup differences in the amplitude except the stance on foam pad with eyes open when SwDS had larger sway. The COP velocity and frequency were larger in SwDS than controls in all trials on foam pad. During stances on the foam pad SwDS increased fractal dimension showing higher complexity of their equilibrium system, while controls decreased sample entropy exhibiting more conscious control of posture in comparison to the stances on hard support surface. This indicated that each group used entirely different adjustments of postural strategies to the somatosensory challenge. It is proposed that the inferior postural control of SwDS results mainly from insufficient experience in dealing with unpredictable postural stimuli and deficit in motor learning.     

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.