Sensori-motor integration during stance: Time adaptation of control mechanisms on adding or removing vision

Sudden addition or removal of visual information can be particularly critical to balance control. The promptness of adaptation of stance control mechanisms is quantified by the latency at which body oscillation and postural muscle activity vary after a shift in visual condition. In the present study, volunteers stood on a force platform with feet parallel or in tandem. Shifts in visual condition were produced by electronic spectacles. Ground reaction force (center of foot pressure, CoP) and EMG of leg postural muscles were acquired, and latency of CoP and EMG changes estimated by t-tests on the averaged traces. Time-to-reach steady-state was estimated by means of an exponential model. On allowing or occluding vision, decrements and increments in CoP position and oscillation occurred within about 2 s. These were preceded by changes in muscle activity, regardless of visual-shift direction, foot position or front or rear leg in tandem. These time intervals were longer than simple reaction-time responses. The time course of recovery to steady-state was about 3 s, shorter for oscillation than position. The capacity of modifying balance control at very short intervals both during quiet standing and under more critical balance conditions speaks in favor of a necessary coupling between vision, postural reference, and postural muscle activity, and of the swiftness of this sensory reweighing process.     

Influence of postural regulation in male judokas' direction of falls

In competitions, judokas tend to have a predominant direction of fall: forwards or backwards. A relationship was hypothesized between the direction of fall and certain parameters of the judokas' postural activities. 20 judokas, 16 to 19 yr. old (17.7 +/- 0.4 yr.), had practised judo for at least seven years. They were separated into two groups. The group of forward fallers (n = 9) and the group of backward fallers (n = 11) performed posturokinetic tests to assess their static and dynamic balance. One parameter assessed through the analysis of postural activities, the average position of anteroposterior dynamic oscillations, was inversely related to the judokas' direction of fall. Postural activities might not play a direct role but perhaps an indirect one in the direction of falls by expert judokas.     

Effect of altered surfaces on postural sway characteristics in elderly subjects

Mobility is essentially based on successful balance control. The evaluation of functional strategies for postural stability is requisite for effective balance rehabilitation and fall prevention in elderly subjects. Our objective was to clarify control mechanisms of different standing positions reflecting challenges of typical everyday life situations. For this purpose, elderly subjects stood on different surfaces resulting in a change of the biomechanical constraints. Sway parameters out of time and frequency domain were calculated from center-of-pressure (COP) excursions. Besides the classic quantification of the amount of sway variability, we investigated the temporal organization of postural sway by means of nonlinear time series analysis. Limb load symmetry was quantified via foot pressure insoles. We found task dependent motor outputs: (1) asymmetrical loading in all conditions; (2) altered amount and structure of COP movements with dissimilar changes in medio-lateral and anterior–posterior direction; (3) changes of the motor output affect several time scales especially when standing on a balance board or with one foot on a step. Our results indicate that elderly subjects preferred forcefully one limb which supports a step-initiation strategy. Modifications of the postural sway structure refer to the interaction of multiple control mechanisms to cope with the altered demands. The identification of postural strategies employed in daily activities augments the ecological validity of postural control studies.     

Premovement posture and focal movement velocity affects on postural responses accompanying rapid arm movement

Coordination of intentional upper limb movement concurrent with supporting postural activity was investigated in adult males under varying task conditions. Seven subjects performed a 60 deg rapid elbow flexion (focal movement) to a target in movement times of 170, 195, or 220 ms while standing. Measurement of center of pressure via a force platform revealed that subjects adopted individual premovement postural preferences such that locus of center of pressure resided in one predominant quadrant of the foot. Each premovement postural preference was accompanied by one most common postural muscle onset sequence as indicated by bilateral EMG analysis of rectus femoris and biceps femoris. In addition, onset times for postural muscles exhibiting anticipatory postural activity occurred earlier relative to biceps branchii as focal movement velocity increased. The finding that each premovement postural condition was accompanied by one particular postural muscle onset sequence suggested that postural synergies were flexibly organized with respect to onset sequence.     

Age Group Differences in Postural Adjustments Associated With a Stepping Task

In this study, differences among age groups in the postural adjustments associated with a stepping task were identified. Twenty subjects from each of 3 age groups, children (8-12 years), young adults (25-35 years), and older adults (65ndash73 years), performed the task in 2 movement contexts: place and step. In place, the subject simply lifted the foot and placed it on the step. In step, the subject lifted the foot, placed it on the step, and stepped up onto the step. Latencies of postural and focal muscle activation were determined by using surface electromyography and pressure switches. Center of pressure (CP) data were obtained by using a force platform. Subjects in all 3 age groups consistently demonstrated postural adjustments before movement initiation. Children displayed longer postural latencies than young adults as well as disproportionately large values for CP path length. Older adults showed prolonged postural-focal latencies and decreased CP excursions compared with the 2 younger age groups. These results suggest that maturation of coordination between posture and movement may not be fully complete in 8- to l2-year-olds and that increased restraint characterizes the performance of postural adjustments in healthy persons over 65 years of age.     

The effects of foot cooling on postural muscle responses to an unexpected loss of balance

The purpose of this study was to examine the role of foot sole somatosensory information during reactive postural control. Twenty young adults (22.0 ± 1.4 y) participated in this study. Baseline skin sensitivity from the foot sole was assessed using Semmes-Weinstein monofilaments. Postural muscle responses, in the form of electromyographic (EMG) onset latencies and amplitudes, were then obtained while participants recovered their balance while standing on a moveable platform that could translate in either the forward or backward direction. Following these baseline measures, the participant’s foot soles were immersed in a 0–2 °C ice-water bath for 12 min followed by a 3 min re-immersion period. At the completion of foot cooling, foot sole sensitivity and postural muscle responses to the balance perturbations were re-assessed. Results indicated that the foot cooling protocol reduced foot sole sensitivity and remained reduced throughout the duration of the experiment (p < 0.001). The reduction in foot sole somatosensation resulted in the soleus EMG onset latency being delayed by 3 ms (p = 0.041) and the soleus and medial gastrocnemius EMG amplitudes increasing by 14–23% (p = 0.002–0.036) during the balance perturbation trials. While the magnitude of these results may suggest that foot cooling has a minor functional consequence on reactive postural control, it is likely that the results also reflect the ability of the central nervous system to rapidly adapt to situations with altered somatosensory feedback.     

Dimensionality and the dynamics of human unstable equilibrium

Maintaining an unstable equilibrium requires that multiple joints be coordinated so that the center of mass is kept above the base of support. The authors' aim in the present study was to discover the underlying dynamics of local (foot, hip, or head) and global (center of mass) components involved in balance control and how those dynamics are affected by changes in the available information. Participants (N = 6) had to maintain their balance on an unstable platform. Using dimensional analyses (largest Lyapunov exponent and correlation dimension), the authors examined the active degrees of freedom involved in balance control. Results indicated a similarity in dimension between local (joints) and global (center of mass) components, between a fixed point and a limit cycle. The behavior of the center of mass was found to be more predictable than the behavior of its local constituents. In addition, the available visual information affected the predictability of the postural behavior, which suggests that vision is used in the stabilization of the low-dimensional dynamics underlying balance control.     

Anticipatory Postural Adjustments for Altering Direction During Walking

The authors examined how individuals adapt their gait and regulate their body configuration before altering direction during walking. Eight young adults were asked to change direction during walking with different turning angles (0deg;, 45deg;, 90deg;), pivot foot (left, right), and walking speeds (normal and fast). The authors used video and force platform systems to determine participants' whole-body center of mass and the center of pressure during the step before they changed direction. The results showed that anticipatory postural adjustments occurred during the prior step and occurred earlier for the fast walking speed. Anticipatory postural adjustments were affected by all 3 variables (turn angle, pivot foot, and speed). Participants leaned backward and sideward on the prior step in anticipation of the turn. Those findings indicate that the motor system uses central control mechanisms to predict the required anticipatory adjustments and organizes the body configuration on the basis of the movement goal.     

Postural fluctuations during pointing from a unilateral or bilateral stance

An experiment was conducted to compare the effects of bilateral and unilateral stance on postural fluctuations and intralimb coordination during active balance control. Fifteen participants stood bilaterally and unilaterally while conducting a pointing task with an outstretched arm. Excursion of center of foot pressure (CoP) and limb movements were recorded with a force plate and eight dual-axis accelerometers, respectively. Compared to bilateral stance, unilateral stance resulted in wider CoP trajectories and greater postural fluctuations, especially in the lower limbs. The limb-dependent postural fluctuations during unilateral stance were associated with an increased coupling between the upper limb segments and a decreased coupling between the segments of the stance leg. Unilateral stance further resulted in greater regularity and spectral changes in postural fluctuations of the trunk and lower limb due to increased central oscillations (8-15 Hz). The observed structural differences in postural fluctuations between unilateral and bilateral stance strongly suggested that the postural control system modulates joint stiffness in a stance-dependent manner. Probably, in unilateral stance, attentive control was shifted to the stance leg at the expense of increasing arm stiffness to reduce movement redundancy.     

Anticipatory postural adjustments for altering direction during walking

The authors examined how individuals adapt their gait and regulate their body configuration before altering direction during walking. Eight young adults were asked to change direction during walking with different turning angles (0 degree, 45 degree, 90 degree), pivot foot (left, right), and walking speeds (normal and fast). The authors used video and force platform systems to determine participants' whole-body center of mass and the center of pressure during the step before they changed direction. The results showed that anticipatory postural adjustments occurred during the prior step and occurred earlier for the fast walking speed. Anticipatory postural adjustments were affected by all 3 variables (turn angle, pivot foot, and speed). Participants leaned backward and sideward on the prior step in anticipation of the turn. Those findings indicate that the motor system uses central control mechanisms to predict the required anticipatory adjustments and organizes the body configuration on the basis of the movement goal.     

Does monopedal postural balance differ between the dominant leg and the non-dominant leg? A review

The interlimb postural comparison i.e., between the dominant leg and the non-dominant leg has been studied by numerous authors but their results are contradictory and do not lead to a consensus. Some studies showed no difference of postural balance between the dominant and the non-dominant leg whereas other studies concluded that the dominant and non-dominant leg exhibit different postural balance in healthy subjects and athletes. The aim was to analyse all these studies in order to identify the different factors that could facilitate or prevent the appearance of a postural difference between the dominant and non-dominant leg by means of a narrative review. Environmental and experimental conditions (e.g., difficulty and specificity of postural tasks; physiological state, expertise level and moment of season/period over career of subjects/athletes evaluated and nature of sport/physical activity practiced; techniques and methods used for measuring postural balance) in which postural balance is evaluated and intrinsic/individual factors (e.g., morphology, strength/power muscle, proprioception, hemispheric laterality) could influence the results. Thus, the influence of limb dominance on monopedal postural balance would probably be context-dependent. Mechanistic explanations are proposed to explain how each factor could act on the relationship between limb dominance and postural balance. However many mechanisms have not yet been explained and all the factors have not been identified, which suggests that further exploratory research is needed in order to understand this relationship.     

Static balance and developmental coordination disorder

The development of static balance is a basic characteristic of normal motor development. Most of the developmental motor tests include a measure of static balance. Children with a developmental coordination disorder (DCD) often fail this item. Twenty-four children at risk for DCD with balance problems (DCD-BP) and 24 matched control children in the age range of 6-12 years participated in a detailed study of balance control. Additional groups of children (6-7 years, N=25; 10-11 years, n=16; with M-ABC scores >15th percentile) were selected randomly to study developmental changes in balance control in the age range of interest. Three experiments were conducted to examine developmental and clinical differences in the control of static balance. In the first, we measured the excursion of the centre of pressure (force-plate) in conditions with and without vision while standing still on one or two legs for 20 s. In the second experiment, EMGs were measured while standing on one leg. In the third experiment, in which only a subgroup of the DCD-BP and matched control children participated, a short unexpected force in the back lightly perturbed normal standing and EMG and force-plate responses were measured during balance recovery. In conditions of one-leg stance, children were not always able to maintain balance. Only epochs of stable postural control (7.5-20 s) were analysed. The results showed improvement of static balance with age, but only subtle differences between the DCD and control groups. Centre of pressure measures differed in the more difficult conditions. DCD-BP children had more difficulty standing on one leg with eyes closed. While standing on the non-preferred leg the EMGs of the DCD-BP children showed slightly more co-activation of the muscles of lower and upper leg. Perturbation of standing resulted in longer duration of recovery in the first trial in this group. Apparently DCD children learn to compensate for the perturbation within a few trials as well as control children do. The clear improvement with age shows that our measures of balance control are sensitive to detect changes. The general conclusion that may be drawn from this study is that under normal conditions static balance control is not a problem for children with DCD. Only in difficult or novel situations they seem to suffer from increased postural sway as a result of non-optimal balance control.     

Balancing cognitive control: How observed movements influence motor performance in a task with balance constraints

We investigated the influence of observed movements on executed movements in a task requiring lifting one foot from the floor while maintaining whole-body balance. Sixteen young participants (20–30 years) performed foot lift movements, which were either cued symbolically by a letter (L/R, indicating to lift the left/right foot) or by a short movie showing a foot lift movement. In the symbol cue condition, stimuli from the movie cue condition were used as distractors, and vice versa. Anticipatory postural adjustments (APAs) and actual foot lifts were recorded using force plates and optical motion capture. Foot lift responses were generally faster in response to the movie compared to the symbol cue condition. Moreover, incongruent movement distractors interfered with performance in the symbol cue condition, as shown by longer response times and increased number of APAs. Latencies of the first (potentially wrong) APA in a trial were shorter for movie compared to symbol cues but were not affected by cue-distractor congruency. Amplitude of the first APA was smaller when it was followed by additional APAs compared to trials with a single APA. Our results show that automatic imitation tendencies are integrated with postural control in a task with balance constraints. Analysis of the number, timing and amplitude of APAs indicates that conflicts between intended and observed movements are not resolved at a purely cognitive level but directly influence overt motor performance, emphasizing the intimate link between perception, cognition and action.     

The effects of pain and a secondary task on postural sway during standing

BackgroundPain impairs available cognitive resources and somatosensory information, but its effects on postural control during standing are inconclusive. The aim of this study was to investigate whether postural sway is affected by the presence of pain and a secondary task during standing.MethodsSixteen healthy subjects stood as quiet as possible at a tandem stance for 30s on a force platform at different conditions regarding the presence of pain and a secondary task. Subjects received painful stimulations on the right upper arm or lower leg according to a relative pain threshold [pain 7 out 10 on a Visual Analog Scale (VAS) - 0 representing “no pain” and 10 “worst pain imaginable”] using a computer pressurized cuff. The secondary task consisted of pointing to a target using a head-mounted laser-pointer as visual feedback. Center of Pressure (COP) sway area, velocity, mean frequency and sample entropy were calculated from force platform measures.FindingsCompared to no painful condition, pain intensity (leg: VAS = 7; arm VAS = 7.4) increased following cuff pressure conditions (P < .01). Pain at the leg decreased COP area (P < .05), increased COP velocity (P < .05), mean frequency (P < .05) and sample entropy (P < .05) compared with baseline condition regardless the completion of the secondary task. During condition with pain at the leg, completion of the secondary task reduced COP velocity (P < .001) compared with condition without secondary task.InterpretationPain in the arm did not affect postural sway. Rather, postural adaptations seem dependent on the location of pain as pain in the lower leg affected postural sway. The completion of a secondary task affected postural sway measurements and reduced the effect of leg pain on postural sway. Future treatment interventions could benefit from dual-task paradigm during balance training aiming to improve postural control in patients suffering from chronic pain.     

Effects of postural anxiety on the soleus H-reflex

Previous research has proposed that spinal reflex modulation may mediate anxiety-related changes in postural control. This study investigated how soleus H-reflex amplitude was influenced by standing at heights that induced different levels of anxiety. H-reflexes were elicited in 15 participants standing at the center and edge of a platform raised from a low to a high height (with and without vision). Increased skin conductance confirmed the anxiety effect of elevated surface heights. When standing at the edge of the platform with vision, H-reflex amplitude was attenuated in the high compared to low height condition. Changes in background muscle activity could not explain observed H-reflex changes, suggesting the potential involvement of pre-synaptic inhibition or fusimotor drive on anxiety-related changes in reflex modulation. This study reveals that healthy participants reduce spinal reflex excitability in the presence of increased postural anxiety and a postural threat imposed by standing at the edge of a raised platform. These findings have implications for understanding control of standing balance in individuals with postural instability and/or fear of falling, such as the elderly or stroke.     

How attentional focus on body sway affects postural control during quiet standing

The purpose of this study was to investigate how attentional focus on body sway affects postural control during quiet standing. To address this issue, sixteen young healthy adults were asked to stand upright as immobile as possible on a force platform in both Control and Attention conditions. In the latter condition, participants were instructed to deliberately focus their attention on their body sways and to increase their active intervention into postural control. The critical analysis was focused on elementary motions computed from the centre of pressure (CoP) trajectories: (1) the vertical projection of the centre of gravity (CoG_v) and (2) the difference between CoP and CoG_v (CoP–CoG_v). The former is recognised as an index of performance in this postural task, whilst the latter constitutes a fair expression of the ankle joint stiffness and is linked to the level of neuromuscular activity of the lower limb muscles required for controlling posture. A frequency-domain analysis showed increased amplitudes and frequencies of CoP–CoG_v motions in the Attention relative to the Control condition, whereas non-significant changes were observed for the CoG_v motions. Altogether, the present findings suggest that attentional focus on body sway, induced by the instructions, promoted the use of less automatic control process and hampered the efficiency for controlling posture during quiet standing.     

Undisturbed upright stance control in the elderly: Part 1. Age-related changes in undisturbed upright stance control

The authors investigated age-related changes in postural control in 33 healthy young adults (18-31 years), 29 seniors (62-75 years), and 22 elderly people (75-96 years). A force platform recorded the results. The horizontal motions of the center of gravity (CGh) and their difference in the plane of support CP - CGv were deduced from the complex center of pressure (CP) trajectories. With fractional Brownian modeling, one can establish that the aging process seems to induce a transition phase in which seniors take more time to initiate the corrective process in the mediolateral (ML) axis than do younger people. The elderly develop a new strategy characterized by the mobilization of higher neuromuscular energy to maintain equilibrium. In the ML axis, the larger displacements could be caused mainly by a hip strategy that could facilitate step initiation. In the anteroposterior (AP) axis, seniors and elderly individuals maintain a relative ability to stabilize their CG into the base of support compared with younger people.     

Influence of wearing an unstable shoe construction on compensatory control of posture

This study investigated the influence of wearing unstable shoe construction (WUS) on compensatory postural adjustments (CPA) associated with external perturbations. Thirty-two subjects stood on a force platform resisting an anterior-posterior horizontal force applied to a pelvic belt via a cable, which was suddenly released. They stood under two conditions: barefoot and WUS. The electromyographic (EMG) activity of gastrocnemius medialis, tibialis anterior, rectus femoris, biceps femoris, rectus abdominis, and erector spinae muscles and the center of pressure (CoP) displacement were acquired to study CPA. The EMG signal was used to assess individual muscle activity and latency, antagonist co-activation and reciprocal activation at joint and muscle group levels. Compared to barefoot, WUS led to: (1) increased gastrocnemius medialis activity, (2) increased total agonist activity, (3) decreased antagonist co-activation at the ankle joint and muscle group levels, (4) increased reciprocal activation at the ankle joint and muscle group levels, and (5) decrease in all muscle latencies. No differences were observed in CoP displacement between conditions. These findings demonstrate that WUS led to a reorganization of the postural control system associated to improved performance of some components of postural control responses.     

First-order statistics of human stabilogram

We investigated the statistical properties of the centre of pressure (COP) vector during quiet standing, as measured on a force platform. To derive a statistical model for the data, the COP vector, locally averaged COP, and deviations from the average COP were analysed. Whereas indefinite multimodal distributions for the components of the COP were observed, the density functions of deviation from the averaged COP had reproducible properties. The anterior-posterior and mediolateral components of the deviations had in common that they were correlated variables with a non-circular statistic. The main axes of the equiprobability density curves were rotated with respect to the natural anterior-posterior and mediolateral directions. By means of more detailed statistical analysis of the data, two distinct populations of subjects were identified. In some cases we have found Gaussian distributions of the components of deviation from the average COP. In most cases the statistics was non-Gaussian. The average contrast, a new dimensionless characteristic quantity, independent of platform calibration, was introduced as a useful indicator of non-Gaussian effects in the postural control system.     

Different neuromuscular control mechanisms regulate static and dynamic balance: A center-of-pressure analysis in young adults

The analysis of the center of pressure (CoP) trajectory, derived from force platforms, is a widely accepted measure to investigate postural balance control. The CoP trajectory could be analyzed as a physiological time-series through a general stochastic modeling framework (i.e., Stabilogram Diffusion Analysis (SDA)). Critical point divides short-term from long-term regions and diffusion coefficients reflect the level of stochastic activity of the CoP. Sample Entropy (SampEn) allows quantifying the CoP complexity in terms of regularity. Thus, this study aimed to understand whether SDA and SampEn could discriminate the neuromuscular control mechanisms underpinning static and dynamic postural tasks. Static balance control and its relationship with dynamic balance control were investigated through the CoP velocity (Mean Velocity) and the area of the 95th percentile ellipse (Area95). Balance was assessed in 15 subjects (age: 23.13 ± 0.99 years; M = 9) over a force platform under two conditions: static (ST) and dynamic, both in anterior-posterior (DAP) and medio-lateral (DML) directions. During the DAP and DML, subjects stood on an unstable board positioned over a force platform. Short-term SDA diffusion coefficients and critical points were lower in ST than in DAP and DML (p < 0.05). SampEn values resulted greater in ST than in DAP and DML (p < 0.001). As expected, lower values of Area95 (p < 0.001) and Mean Velocity (p < 0.001) were detected in the easiest condition, the ST, compared to DAP and DML. No significant correlations between static and dynamic balance performances were detected. Moreover, differences in the diffusion coefficients were detected comparing DAP and DML (p < 0.05). In the anterior-posterior direction, the critical point occurred at relatively small intervals in DML compared to DAP (p < 0.001) and ST (p < 0.001). In the medio-lateral direction, the critical point differed only between DAP and DML (p < 0.05). Overall, SDA analysis pointed out a less tightly regulated neuromuscular control system in the dynamic tasks, with closed-loop corrective feedback mechanisms called into play at different time intervals in the three conditions. SampEn results reflected more attention and, thus, less automatic control mechanisms in the dynamic conditions, particularly in the medio-lateral task. The different neuromuscular control mechanisms that emerged in the static and dynamic balance tasks encourage using both static and dynamic tests for a more comprehensive balance performance assessment.