The effects of visual input on postural control mechanisms: an analysis of center-of-pressure trajectories using the auto-regressive model

New measures to characterize center-of-pressure (COP) trajectories during quiet standing were proposed and then utilized to investigate changes in postural control with respect to visual input. Eleven healthy male subjects (aged 20-27 years) were included in this study. An instrumented force platform was used to measure the time-varying displacements of the COP under each subject's feet during quiet standing. The subjects were tested under eyes-open and eyes-closed conditions. The COP time series were separately analyzed for the medio-lateral and antero-posterior directions. The proposed measures were obtained from the parameter estimation of auto-regressive (AR) models. The percentage contributions and geometrical moment of AR coefficients showed statistically significant differences between vision conditions. The present COP displacements under the eyes-open condition showed higher correlation with the past COP displacements at longer lag times, when compared to the eyes-closed condition. In contrast, no significant differences between vision conditions were found for conventional summary statistics, e.g., the total length of the COP path. These results suggest that the AR parameters are useful for the evaluation of postural stability and balance function, even for healthy young individuals. The role of visual input in the postural control system and implications of the findings were discussed.     

Effects of asymmetric load carrying on the biomechanics of walking

The purpose of the study was to investigate the effects of an asymmetric sidepack carrying system on frontal plane joint moments of force in both lower extremities and in the L5/S1 joint during level walking. Ground reaction force data and frontal plane film records were obtained from five males performing three walking conditions: 0, 10 and 20% bodyweight loads in a sidepack supported by the left shoulder. Inverse dynamics were used to calculate the lower extremity moments during stance and a static model of the pelvis was used to calculate the L5/S1 moments during single support for each limb. Normal walking was characterized by symmetric kinetics between left and right limbs and around the L5/S1 joint. The asymmetric loads produced unbalanced lateral trunk muscle dominance between left and right limb stance phases, increased right hip and knee moments and decreased left hip and knee moments. During normal walking, the L5/S1 moment was dominant on the contralateral trunk side for both limbs. The asymmetric loads applied to the left side caused a shift in L5/S1 moment dominance to the right side during left and right single support phases.     

Age-related reduction in sagittal plane center of mass motion during obstacle crossing

Accidental falls are a leading cause of injury and death in the growing elderly population. Traumatic falls are frequent, costly, and debilitating. Control of balance during locomotion is critical for safe ambulation, but relatively little is known about the natural effect of aging on dynamic balance control. Samples of healthy young (n = 13) and elderly (n = 13) subjects were compared in the interactive measures of center of mass (COM) and center of pressure (COP) during level walking and obstacle crossing conditions. Obstacle heights were normalized to individual body height (2.5%, 5%, 10%, and 15%). Temporal-distance (T-D) variables of gait were also compared. Statistical analyses were conducted using a two-way ANOVA for subject group and obstacle height. T-D parameters were not significantly different between groups; nor were frontal plane COM and COP parameters. Significant age differences did exist for antero-posterior (A/P) motion of the COM (decreased motion in the elderly), and its relationship with the COP (reduced separation between the two variables in the elderly). Anterior COM velocities were also significantly lower in the elderly group. The results confirm the ability of healthy elderly adults to maintain dynamic balance control in the frontal plane during locomotion. Reduced A/P distances between the COM and COP indicate a conservative reduction of the mechanical load on joints of the supporting limb. This conservative strategy may be related to a reduction in muscle strength as it occurs in the natural aging process.     

Hip recovery strategy used by below-knee amputees following mediolateral foot perturbations

Lower-limb amputees have a higher risk of falling compared to non-amputees. Proper regulation of whole-body angular momentum is necessary to prevent falls, particularly in the frontal plane where individuals are most unstable. However, the balance recovery mechanisms used by lower-limb amputees when recovering from a perturbation are not well-understood. This study sought to understand the balance recovery mechanisms used by lower-limb amputees in response to mediolateral foot perturbations by examining changes to frontal plane whole-body angular momentum and hip joint work. These metrics provide a quantitative measure of frontal plane dynamic balance and associated joint contributions required to maintain balance during gait. Nine amputees and 11 non-amputees participated in this study where an unexpected medial or lateral foot placement perturbation occurred immediately prior to heel strike on the residual, sound or non-amputee limbs. Lateral perturbations of all limbs resulted in a reduced range of whole-body angular momentum and increased positive frontal plane hip work in the first half of single limb support. Medial perturbations for all limbs resulted in increased range of whole-body angular momentum and decreased positive frontal plane hip work, also in the first half of single limb support. These results suggest that medial foot placement perturbations are particularly challenging and that hip strategies play an important role in balance recovery. Thus, rehabilitation interventions that focus on hip muscles that regulate mediolateral balance, particularly the hip abductors, and the use of prostheses with active ankle control, may reduce the risk of falls.     

The effects of total ankle arthroplasty on postural stability and loading symmetry in quiet stance

Ankle osteoarthritis is a debilitating condition affecting about 1% of the population with approximately 50,000 new instances annually. One treatment is total ankle arthroplasty (TAA), however, its effects on balance are not well understood. This study analyzed balance over a two-year period following TAA. 408 subjects (177 left, 231 right ankles) diagnosed with end-stage ankle osteoarthritis performed quiet standing trials while center of pressure (COP) data were collected. Data were compared across three time points (pre-op, 1-year, and 2-years post-op) and between surgical and non-surgical limbs using a linear mixed model with significance set at P = 0.05. COP excursions in the feet-together condition were not significantly different between limbs after 2 years in anteroposterior or mediolateral directions (P = 0.06, 0.08) after being significantly different between limbs in the anteroposterior (P = 0.014) and mediolateral direction (P < 0.001) pre-op. The vertical ground reaction force significantly decreased across time in the non-surgical limb, while reciprocally increasing in the surgical limb (P < 0.001). After 2 years, no significant difference in vertical ground reaction force between limbs existed (P = 0.20). Limb asymmetry indices decreased at each time point in both conditions (all P < 0.001) and were not significantly different from zero after 2 years in the feet-together condition (P = 0.290). In conclusion, surgical limb balance improved compared to pre-op, resulting in increased symmetry between limbs after 2 years. Vertical ground reaction forces on both limbs converge and limb asymmetry indices approach zero two years post-op. Differences in the COP excursion-loading symmetry relationship between limbs could be useful for identifying instability in other pathologies.     

Relative Roles of the Ankle and Hip Muscles in Human Postural Control in the Frontal Plane during Standing

The main goal was to evaluate the relative roles of the ankle and hip muscles in human postural control in the frontal plane during normal upright standing. Experiments were designed to compare upright standing with and without the involvement of the ankle joint. The results demonstrated that standing balance in the frontal plane depended largely on the hip muscles and just slightly on the ankle muscles, which performed only small adjusting movements in the frontal plane. During quiet standing, the human body swayed in the frontal plane as a two-component inverted pendulum or, when no ankle joint torque was permitted, as an inverted pendulum consisting of only one component.     

Oscillations of upper and lower body segments in the sagittal plane during standing: Spatiotemporal relationships

The balance control in the sagittal plane during standing without visual feedback has been studied in the context of the notion that a human body can be presented as a two-segment inverted pendulum. The oscillations of the center of pressure and of the upper and lower segments were recorded for 2 min (ten records for each of seven volunteers). It is shown that the correlation coefficients and dynamic similarity between the oscillation of the upper segment and the center of pressure are significantly higher than between the lower segment and the center of pressure. The dynamic similarity between the oscillations of the upper segment in different records are higher than between the oscillations of the lower one, which is supposedly connected with the necessity of stabilizing the head in space during standing. The oscillations of the lower segment occurred with a mean delay of 16.2 ± 9.0 ms relative to those of the upper segment. At the same time, the distribution of the delays has a peak at zero, indicating that two strategies of balance control are used during quiet standing, which are described in the one-segment and the two-segment inverted pendulum models.     

The effect of textured surfaces on postural stability and lower limb muscle activity

Textured insoles may enhance sensory input on the plantar surfaces of the feet, thereby influencing neuromuscular function. The aim of this study was to investigate whether textured surfaces alter postural stability and lower limb muscle activity during quiet bipedal standing balance with eyes open. Anterior–posterior (AP) and mediolateral (ML) sway variables and the intensity of electromyographic (EMG) activity in eight dominant lower limb muscles were collected synchronously over 30 s in 24 young adults under three randomised conditions: control surface (C), texture 1 (T1) and texture 2 (T2). Repeated measures ANOVA showed that the textured surfaces did not significantly affect AP or ML postural sway in comparison to the control condition (p > 0.05). Neither did the textured surfaces significantly alter EMG activity in the lower limbs (p > 0.05). Under the specific conditions of this study, texture did not affect either postural sway or lower limb muscle activity in static bipedal standing. The results of this study point to three areas of further work including the effect of textured surfaces on postural stability and lower limb muscle activity: (i) in young healthy adults under more vigorous dynamic balance tests, (ii) post-fatigue, and (iii) in older adults presenting age-related deterioration.     

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 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.     

Frontal plane moments do not accurately reflect ankle dynamics during running

The ankle joint has typically been treated as a universal joint with moments calculated about orthogonal axes and the frontal plane moment generally used to represent the net muscle action about the subtalar joint. However, this joint acts about an oblique axis. The purpose of this study was to examine the differences between joint moments calculated about the orthogonal frontal plane axis and an estimated subtalar joint axis. Three-dimensional data were collected on 10 participants running at 3.6 m/s. Joint moments, power, and work were calculated about the orthogonal frontal plane axis of the foot and about an oblique axis representing the subtalar joint. Selected parameters were compared with a paired t-test (alpha = 0.05). The results indicated that the joint moments calculated about the two axes were characteristically different. A moment calculated about an orthogonal frontal plane axis of the foot resulted in a joint moment that was invertor in nature during the first half of stance, but evertor during the second half of stance. The subtalar joint axis moment, however, was invertor during most of the stance. These two patterns may result in qualitatively different interpretations of the muscular contributions at the ankle during the stance phase of running.     

Joint moment contributions to swing knee extension acceleration during gait in children with spastic hemiplegic cerebral palsy

Inadequate peak knee extension during the swing phase of gait is a major deficit in individuals with spastic cerebral palsy (CP). The biomechanical mechanisms responsible for knee extension have not been thoroughly examined in CP. The purpose of this study was to assess the contributions of joint moments and gravity to knee extension acceleration during swing in children with spastic hemiplegic CP. Six children with spastic hemiplegic CP were recruited (age=13.4±4.8 years). Gait data were collected using an eight-camera system. Induced acceleration analysis was performed for each limb during swing. Average joint moment and gravity contributions to swing knee extension acceleration were calculated. Total swing and stance joint moment contributions were compared between the hemiplegic and non-hemiplegic limbs using paired t-tests (p<0.05). Swing limb joint moment contributions from the hemiplegic limb decelerated swing knee extension significantly more than those of the non-hemiplegic limb and resulted in significantly reduced knee extension acceleration. Total stance limb joint moment contributions were not statistically different. Swing limb joint moment contributions that decelerated knee extension appeared to be the primary cause of inadequate knee extension acceleration during swing. Stance limb muscle strength did not appear to be the limiting factor in achieving adequate knee extension in children with CP. Recent research has shown that the ability to extend the knee during swing is dependent on the selective voluntary motor control of the limb. Data from individual participants support this concept.     

Time-to-boundary measures of postural control during single leg quiet standing

A novel approach to quantifying postural stability in single leg stance is assessment of time-to-boundary (TTB) of center of pressure (COP) excursions. TTB measures estimate the time required for the COP to reach the boundary of the base of support if it were to continue on its instantaneous trajectory and velocity, thus quantifying the spatiotemporal characteristics of postural control. Our purposes were to examine: (a) the intrasession reliability of TTB and traditional COP-based measures of postural control, and (b) the correlations between these measures. Twenty-four young women completed three 10-second trials of single-limb quiet standing on each limb. Traditional measures included mean velocity, standard deviation, and range of mediolateral (ML) and anterior-posterior (AP) COP excursions. TTB variables were the absolute minimum, mean of minimum samples, and standard deviation of minimum samples in the ML and AP directions. The intrasession reliability of TTB measures was comparable to traditional COP based measures. Correlations between TTB and traditional COP based measures were weaker than those within each category of measures, indicating that TTB measures capture different aspects of postural control than traditional measures. TTB measures provide a unique method of assessing spatiotemporal characteristics of postural control during single limb stance.     

Moderate alterations in lower limbs muscle temperature do not affect postural stability during quiet standing in both young and older women.

Older adults demonstrate increased amounts of postural sway, which may ultimately lead to falls. Temperature is known to have a profound effect on the performance of the neuromuscular system which could have important implications on motor control. It is, therefore, of interest to investigate if the age-related decline in postural stability could be affected by changes in local limbs temperature. The present study investigated the effects of localized warming and cooling on postural sway in nine young (22+/-3 years) and nine older (73+/-3 years) women. Postural sway was assessed, using a single force platform, during quiet standing at three muscle temperature conditions: control (34.2+/-0.2 degrees C), cold (31.3+/-0.3 degrees C) and warm (37.0+/-0.1 degrees C). Two stances were evaluated, the Romberg (large support base) and modified Tandem (narrow support base), under both eyes-open and eyes-closed conditions. Root mean square (RMS), mean velocity (MV), sway area (SA) and mean power frequency (MPF) were calculated from the centre of pressure (COP) displacement. Neither warming nor cooling significantly affected any of the postural parameters which were, however, all higher (P<0.05) in the older group than the young group in all conditions. This study demonstrated that, in quiet standing conditions, a moderate variation (+/-3 degrees C) in lower limbs temperature does not affect postural steadiness in either young or older women.     

Nonlinear analysis of the dynamics of the human balance control system during fixation and smooth pursuit of visual target

The similarity between the dynamics of the human balance control system in the frontal and sagittal planes during the fixation of visual stimulus and smooth pursuit of its sinusoidal movements in the horizontal plane with a frequency of 0.1 or 0.01 Hz (so-named fast and slow pursuit) has been investigated by the nonlinear method of analysis. The experiments were carried out according to the notion that it is possible to describe the process of orthograde standing by a two-segment model--upper and lower segments which are connected by a hip joint (other joints were fixed). It was shown that during fixation the similarity between the dynamics of orthostatic control system in the frontal plane is higher than in the sagittal plane. A slow pursuit does not influence the similarity, but a fast one decreases the similarity in the frontal plane. The indices of similarity between the dynamics of the system in the sagittal plane for all the conditions are close and do not differ significantly. The changes in similarity during fast pursuit are supposed to be connected with the different inertia of eyes and body movements. The differences between dynamic similarity in the frontal and sagittal planes are probably connected with the peculiarities of both balance control during joint fixation and AP-ML control (Winter et al., 1993) under conditions investigated.     

Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis

The adduction moment about the knee during walking gait has been proposed as an indirect measure of dynamic knee joint load. However, the relative contributions of the variables primarily used to calculate the knee adduction moment have not been investigated. The objectives of this paper were to: (1) describe and compare the magnitude and temporal characteristics of the knee adduction moment, frontal plane lever arm, and frontal plane ground reaction force (GRF) during gait in patients with knee osteoarthritis (OA) and, (2) examine the associations among these variables. Results indicated that both the knee adduction moment and the frontal plane GRF varied considerably throughout stance and exhibited the characteristic "double-hump" pattern, while the frontal plane lever arm magnitude varied only slightly during stance. Knees with OA had significantly greater peak knee adduction moments and frontal plane lever arms, but significantly less peak frontal plane GRF than knees without OA. Pearson product moment correlations indicated a higher association between peak knee adduction moment and peak frontal plane lever arm than between peak knee adduction moment and peak frontal plane GRF, particularly in knees with OA. These results suggest that the frontal plane lever arm assessed during walking is an important variable in the examination of knee OA, and warrants further investigation.     

Redistribution of intra- and inter-limb support moments during downhill walking on different slopes

Downhill walking presents a greater risk of falling as a result of slipping or loss of balance in comparison with level walking. The current study aimed to investigate the effects of inclination angles on the intra-limb (inter-joint) and inter-limb sharing of the body support during downhill walking for a better understanding of the associated control strategy. Fifteen young male adults (age: 32.6±5.2 years, height: 168.9±5.5 cm, mass: 68.4±8.7 kg) performed level and downhill walking while their kinematic and kinetic data were measured for calculating joint moments and total support moments of the lower limbs using inverse dynamics analysis. The peak total support moments of both the leading and trailing limbs increased with increasing inclination angles (p<0.05) with different sharing patterns among individual joints. Being the major contributor to the peak total support moment during early single-limb support, the contribution of the knee remained unaltered (p>0.05), but the contributions of the hip increased with reduced contributions from the ankle (p<0.05). For the increased peak total support moment during late single-limb support, the intra-limb sharing changed from a major ankle contribution to a major knee contribution strategy. The hip contribution was also increased (p<0.05) but the hip flexor moment remained unaltered (p>0.05). During double-limb support, the main contributor to the whole body support changed from the trailing limb to the leading limb with increasing inclination angles (p<0.05).     

Effects of vibration intensity on lower limb joint moments during standing

Muscle activity and joint moment of the lower limbs can provide different information about the stimulation of controlled whole-body vibration (CWBV) on human body. Previous studies investigated the immediate effects of the intensity of CWBV on enhancing lower-limb muscle activity. However, no study has examined the possible influence of CWBV intensity on joint loading. It remains unexplored how CWBV intensity impacts joint loading. This study was carried out (1) to quantify the effects of CWBV intensity in terms of vibration frequency and amplitude on the lower limb joint moments and (2) to examine the relationship between leg joint moments and vibration intensity characterized by the platform’s acceleration, that is determined by frequency and amplitude, during standing among young adults. Thirty healthy young adults participated in this study. Each participant experienced nine vibration intensity levels dependent upon the frequency (10, 20, and 30 Hz) and amplitude (1, 2, and 3 mm) while standing on a side-alternating vibration platform. Their body kinematics and vertical reaction forces between the feet and platform were collected. Inverse dynamics was employed to calculate the resultant moment for the ankle, knee, and hip joints in the sagittal plane. Our results revealed that the root-mean-square moment significantly increases with increasing vibration frequency or amplitude for all three joints. Further, all joint moments are strongly and positively correlated with the platform acceleration.     

Reduction of neuromuscular redundancy for postural force generation using an intrinsic stability criterion

Postural control requires the coordination of multiple muscles to achieve both endpoint force production and postural stability. Multiple muscle activation patterns can produce the required force for standing, but the mechanical stability associated with any given pattern may vary, and has implications for the degree of delayed neural feedback necessary for postural stability. We hypothesized that muscular redundancy is reduced when muscle activation patterns are chosen with respect to intrinsic musculoskeletal stability as well as endpoint force production. We used a three-dimensional musculoskeletal model of the cat hindlimb with 31 muscles to determine the possible contributions of intrinsic muscle properties to limb stability during isometric force generation. Using dynamic stability analysis we demonstrate that within the large set of activation patterns that satisfy the force requirement for posture, only a reduced subset produce a mechanically stable limb configuration. Greater stability in the frontal-plane suggests that neural control mechanisms are more highly active for sagittal-plane and for ankle joint control. Even when the limb was unstable, the time-constants of instability were sufficiently great to allow long-latency neural feedback mechanisms to intervene, which may be preferential for movements requiring maneuverability versus stability. Local joint stiffness of muscles was determined by the stabilizing or destabilizing effects of moment-arm versus joint angle relationships. By preferentially activating muscles with high local stiffness, muscle activation patterns with feedforward stabilizing properties could be selected. Such a strategy may increase intrinsic postural stability without co-contraction, and may be useful criteria in the force-sharing problem.     

Characterizing the balance-dexterity task as a concurrent bipedal task to investigate trunk control during dynamic balance

The purpose of the study was to characterize the Balance-Dexterity Task as a means to investigate a concurrent bipedal lower-extremity task and trunk control during dynamic balance. The task combines aspects of single-limb balance and the lower-extremity dexterity test by asking participants to stand on one limb while compressing an unstable spring with the contralateral limb to an individualized target force. Nineteen non-disabled participants completed the study, and performance measures for the demands of each limb – balance and dexterous force control – as well as kinematic and electromyographic measures of trunk control were collected. Given five practice trials, participants achieved compression forces ranging from 100 to 139 N (mean 121.2 ± 12.3 N), representing 14.4–23.0% of body weight (mean 18.7 ± 2.4%), which were then presented as target forces during test trials. Dexterous force control coefficient of variation and average magnitude of the center of pressure (COP) resultant velocity were associated such that greater variability in force control was accompanied by greater COP velocity (R = 0.598, p = 0.007). Trunk coupling, quantified as the coefficient of determination (R²) of a frontal plane thorax and pelvis angle-angle plot, varied independently of any measure of balance or dexterous force control. The Balance-Dexterity Task is a continuous, dynamic balance task where bipedal coordination and trunk coupling can be concurrently observed and studied.