Broad stance conditions change postural control and postural sway

Intuitively, a broad stance (i.e., standing with the feet farther apart than usual) should significantly improve postural stability. However, this intuition was not confirmed in quiet stance. Hence, a motion analysis system (markers attached to the trunk and head) and a force platform were used to investigate 13 healthy, young adults who performed 8 trials in standard and broad stances. In broad stance, the medialateral center of pressure (COP) sway mean power frequency was expected to be greater, whereas the variability (standard deviation) of COP, head, and trunk sway and the mean velocity of head and trunk sway was expected to be significantly lower. Accordingly, adoption of a broad stance significantly increased the medialateral mean power frequency of COP sway; decreased the standard deviation of medialateral COP, trunk, and head sway; and decreased the medialateral mean velocity of head sway. A broad stance was also associated with lower variability for head and COP sways in the anteroposterior axis. Unexpectedly, an effect of trial repetition was found for the variability of medialateral trunk sway. This was probably due to the break halfway through the study. In practical terms, broad stance conditions can improve postural control in the medialateral and anteroposterior axes.     

Differences in Rapid Initiation and Termination of Voluntary Postural Sway Associated with Ageing and Falls-Risk

The authors examined differences between young adults (n = 25) and healthy older adults (n = 48) in reaction time and the relations between center of pressure (COP) and center of mass (COM) motions during rapid initiation and termination of voluntary postural sway. Older adults were divided into low and high falls-risk groups based on Physiological Profile Assessment scores of sensorimotor function. Low falls-risk older adults had slower reaction times during anteroposterior sway initiation and decreased COP–COM separation during anteroposterior and medialateral sway initiation and anteroposterior continuous voluntary sway compared with young adults. High falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP–COM separation during sway initiation and continuous voluntary sway in the anteroposterior and medialateral directions compared with young adults. Compared with low falls-risk older adults, high falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP–COM separation during medialateral continuous voluntary sway. Reaction time and COP–COM measures significantly predicted group status in discriminant models with sensitivities and specificities of 72–100%. Overall, these findings highlight important associations of age-related declines in sensorimotor function related to an increased risk of falling with slower postural reaction time and reduced postural stability.     

Influence of vision and static stretch of the calf muscles on postural sway during quiet standing

The purpose of this experimental study was to evaluate the effects of vision and stretching of the calf muscles on postural sway during quiet standing. Under pre-stretch conditions, participants stood on a force plate for 30s and the sway of the ground reaction force center of pressure was recorded. The following postural sway variables were calculated off-line: sweep speed, sway speed, standard deviation, maximal mediolateral range, maximal anteroposterior range, mean mediolateral position and mean anteroposterior position. For post-stretch conditions, participants stood quietly on a device that was utilized to impose a static 3 min ankle joint dorsiflexion stretch. Immediately thereafter, participants moved onto the force platform where postural sway parameters were again recorded. Randomized eyes-open and eyes-closed conditions were tested in both cases. Results showed that postural sway significantly increased due to stretch (sweep speed, sway speed, standard deviation, maximal anteroposterior range, mean anteroposterior position), as well as eye closure (sweep speed, sway speed, standard deviation, maximal mediolateral range, maximal anteroposterior range). The interaction between stretch and eye closure was also significant (sweep speed, sway speed, standard deviation, maximal mediolateral range), suggesting that there were only minor increases in postural sway after stretch under the eyes-open condition. It was suggested that stretching of the calf muscles has the effect of increasing postural sway, although this effect can be greatly compensated for when vision is included.     

Development of postural stability limits: Anteroposterior and mediolateral postural adjustment mechanisms do not follow the same maturation process

There is increasing evidence that indicates a critical transition period for the maturation of postural control from the ages of 6–7 years. Some studies suggest that this transitional period may be explained by a change from a ballistic toward a sensory strategy, but the cause remains unknown. The purpose of this study was to investigate the influence of the transition period on dynamic postural control in a natural self-initiated leaning task under different sensory conditions. We evaluated the center of pressure (COP) displacement during maximum leaning in four directions (forward, backward, rightward, leftward) under three sensory conditions (eyes open, eyes closed and eyes closed standing on a foam). Three groups were tested: young children (4 years old), older children (8–10 years old) and adults (21–42 years old). The maximum COP excursion along the anteroposterior and mediolateral axes and the COP amplitude were analyzed. Young children showed smaller maximum anteroposterior and mediolateral COP excursion than other groups. Older children also exhibited a significantly smaller maximum excursion along the mediolateral direction but performed similar to adults along the anteroposterior direction. In a similar manner, the analysis of the COP amplitude did not indicate any differences between the groups along the anteroposterior axis. In contrast, along the mediolateral axis, the results showed developmental differences. Furthermore, the effect of sensory conditions was similar across the children's groups. Our results suggest an important plasticity period for the maturation of postural control mechanisms. Notably, our findings support the idea that the postural mechanisms controlling the anteroposterior axis reach maturity before the mechanisms involved in controlling the mediolateral axis.     

Assessment of postural control in patients with Parkinson’s disease: Sway ratio analysis

Analysis of the postural stability impairments in neurodegenerative diseases is a very demanding task. Age-related declines in posturographic indices are usually superimposed on effects associated with the pathology and its treatment. We present the results of a novel postural sway ratio (SR) analysis in patients with Parkinson’s disease (PD) and age-matched healthy subjects. The sway ratios have been assessed based upon center of foot-pressure (CP) signals recorded in 55 parkinsonians (Hoehn and Yahr: 1-3) and 55 age-matched healthy volunteers while standing quiet with eyes open (EO) and then with eyes closed (EC). Complementing classical sway measure abnormalities, the SR exhibited a high discriminative power for all controlled factors: pathology, vision, and direction of sway. Both the anteroposterior (AP) and mediolateral (ML) sway ratios were significantly increased in PD patients when compared to the control group. An additional SR increase was observed in the response to eyes closure. The sway ratio changes documented here can be attributed to a progressive decline of a postural stability control due to pathology. In fact, a significant correlation between the mediolateral SR under EO conditions and Motor Exam (section III) score of the UPDRS was found. The mediolateral sway ratios computed for EO and EC conditions significantly correlated with the CP path length (r = .87) and the mean anteroposterior CP position within the base of support (r = .38). Both indices reflect postural stability decline and fall tendency # in parkinsonians. The tremor-type PD patients (N = 34) showed more pronounced relationships between the mediolateral SR and selected items from the UPDRS scale, including: falls (Kendall Tau = .47, p < .05), rigidity (.45, p < .05), postural stability (retropulsion) (.52), and the Motor Exam score (.73). The anteroposterior SR correlated only with tremor (Kendal Tau = .77, p < .05). It seems that in force plate posturography the SR can be recommended as a single reliable measure that allows for a better quantitative assessment of postural stability impairments.     

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.     

Synergies and Motor Equivalence in Voluntary Sway Tasks: The Effects of Visual and Mechanical Constraints

The authors used two analyses developed within the framework of the uncontrolled manifold hypothesis to quantify multimuscle synergies during voluntary body sway: analysis of intertrial variance and analysis of motor equivalence with respect to the center of pressure (COP) trajectory. Participants performed voluntary sway tasks in the anteroposterior direction at 0.33 and 0.66 Hz. Muscle groups were identified in the space of muscle activations and used as elemental variables in the synergy analyses. Changing mechanical and vision feedback–based constraints led to significant changes in indices of sway performance such as COP deviations in the uninstructed, mediolateral direction and indices of spontaneous postural sway. In contrast, there were no significant effects on synergy indices. These findings show that the neural control of performance and of its stability may involve different control variables and neurophysiological structures. There were strong correlations between the indices of motor equivalence and those computed using the intercycle variance analysis. This result is potentially important for studies of patients with movement disorders who may be unable to perform multiple trials (cycles) at any given task, making analysis of motor equivalence of single trials a viable alternative to explore changes in stability of actions.     

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 (CG_h) and their difference in the plane of support CP - CG_v 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.     

The impact of visual flow stimulation on anxiety, dizziness, and body sway in individuals with and without fear of heights

Individuals with acrophobia experience anxiety and dizziness when exposed to heights. It may be that their balance system is disturbed and that they therefore have to rely more strongly on visual information.We tested this hypothesis by exposing 20 individuals with high fear of heights and 20 healthy control participants to nine different visual flow stimuli through a head mounted display, thereby inducing a conflict between visual input and somatosensory information. Anxiety and dizziness were assessed repeatedly by means of self-reports, while resultant body sway was measured continuously with a force plate individuals stood on.Individuals with fear of heights felt more anxious and dizzier, and also showed stronger body sway than healthy control participants.Merely receiving visual balance information contradictory to somatosensory balance information is sufficient to induce anxiety, dizziness, and body sway in individuals with fear of heights. An underlying balance dysfunction may contribute to the development of height phobia.     

Measuring Postural Sway in Sitting: A New Segmental Approach

Global measures of trunk sway are traditionally used even though the trunk comprises a multiple number of segments. The authors’ aim was to measure the seated sway of typically developing children using a multisegment approach. Twenty typically developing children divided into 2 groups, older and younger than 10 years old, participated in this study. The children sat unsupported for 30 s while their posture and sway were quantified using stereophotogrammetry. The tendency in both age groups was to sit with a backward tilted pelvis and a kyphotic trunk. The sitting position was most varied in the younger group. Marker sway amplitude and velocity in sitting were age dependent, with reduced sway amplitude and velocity with increased age for all segments. Anteroposterior intersegmental angular sway was not age dependent. The difference in marker sway in the anteroposterior direction for the younger group appeared to result from an equally stable trunk supported on a less stable pelvis. Mediolateral marker sway and intersegmental angular sway showed a clearer age dependency. Trunk postural control does not appear to differ between children older and younger than 10 years old, but sagittal plane pelvic stability can explain the increased sway reported in younger children.     

Posture control and complex arm coordination: analysis of multijoint coordinative movements and stability of stance

The authors addressed the interactions between control of bimanual multijoint coordination tasks and posture. Participants (N = 6) performed 8 coordination patterns that differed in degree of complexity by using their bilateral elbows and wrists under 3 scaled motion speeds while standing on 2 force plates. Results indicated that producing complex bimanual multijoint coordinative tasks affected postural sway, thus resulting in an increase of sway activity. Behavioral as well as mechanical factors accounted for the increased disturbance in postural sway. Those findings suggest that performing complex coordination tasks disrupts postural control in normal young adults.     

Upright standing after stroke: How loading-unloading mechanism participates to the postural stabilization

Postural strategies employed by hemiparetic stroke patients need to be better understood to guide rehabilitation. Of the two complementary mechanisms used to stabilize the standing posture, loading-unloading (LU) and pressure distribution (PD), it is hypothesized that the former would be predominantly used. To this aim, posturographic assessments, through a dual force-platform, were performed in 30 Hemiparetics tested 3 months after a unilateral stroke, and 30 matched healthy Controls. Original indices (from 0 to 1) were calculated to assess LU and PD contributions. The results show that along the mediolateral axis, the LU contribution was very high and similar in Hemiparetics and in Controls (0.80 ± 0.07 vs 0.76 ± 0.09 a.u; p > 0.05), indicating a predominant hip involvement. Along the anteroposterior axis, the PD contribution was very close to 1 in controls (0.96 ± 0.03 a.u.) indicating an exclusive ankle involvement. Despite a lower contribution in Hemiparetics (0.88 ± 0.11 a.u.; p < 0.01), the indices were surprisingly always above 0.5, meaning that ankle movements remain predominant for controlling postural sways along the anteroposterior axis in all patients even those with severe clinical deficits. However the PD contribution appeared larger in patients with light or moderate deficits of the sensitivity (r = −0.532; p < 0.01) or the motor command (r = −0.513; p < 0.01). These results indicate that postural stabilization of hemiparetic persons remains controlled by a PD mechanism along the anteroposterior axis, even in those combining poor distal motor command and deep sensory loss. This ankle control, piloted by the more-loaded non-paretic limb, would therefore be preferred to a hip control through lateral trunk motion. This should be considered when defining the objectives of the postural rehabilitation after stroke.     

Approximate entropy used to assess sitting postural sway of infants with developmental delay

Infant sitting postural sway provides a window into motor development at an early age. The approximate entropy, a measure of randomness, in the postural sway was used to assess developmental delay, as occurs in cerebral palsy. Parameters used for the calculation of approximate entropy were investigated, and approximate entropy of postural sway in early sitting was found to be lower for infants with developmental delay in the anterior-posterior axis, but not in the medial-lateral axis. Spectral analysis showed higher frequency features in the postural sway of early sitting of infants with typical development, suggesting a faster control mechanism is active in infants with typical development as compared to infants with delayed development, perhaps activated by near-fall events.     

Postural Mechanisms to Control Body Displacements in the Performance of Lateral Gaze Shifts

Medialateral postural control mechanisms (bodyweight distribution and center of pressure location) have been studied in static conditions. Our objective was to determine how these mechanisms are adjusted to perform voluntary movements, in our case 80° lateral gaze shifts at 0.125 Hz and 0.25 Hz. In healthy, young adults, we expected body marker (neck, lower back) and center of pressure displacements to be significantly greater in gaze shift conditions than in the stationary gaze condition. To explain these changes in center of pressure displacement, the amplitude contribution of both mechanisms was expected to increase significantly. All these results were found accordingly. Unexpectedly, the active contribution of the bodyweight distribution mechanism was negatively related to body marker displacements in the gaze shift conditions (ns in stationary condition). Moreover, changes in the contribution of the mechanisms were statistically weaker in effect size than changes in body displacement. However, the participants were not unstable because they performed the visual tasks as requested. We propose that the strength of medialateral postural control mechanisms may not only be strengthened to control challenging ML stance conditions but also slightly weakened to allow the performance of adequate body motions in ongoing tasks.     

Is voluntary control of natural postural sway possible?

The authors explored whether standing human participants could voluntarily decrease the amplitude of their natural postural sway when presented with explicit visual feedback and a target. Participants (N = 9) stood quietly, without any feedback and with feedback on the center of pressure coordinate or the head orientation. They were unable to decrease sway amplitude when presented with visual feedback and a target. Decreasing target size led to contrasting effects on the 2 fractions of sway: rambling and trembling. The smaller target was associated with a decrease in rambling and an increase in trembling. Those observations suggest that sway represents a superposition of at least 2 independent processes. They also suggest that providing visual feedback on a variable tied to body sway may not be an effective way to decrease postural sway in young healthy people.     

Optimization of postural control in precise gaze shifts and laser pointing

Young adults are known to reduce their postural sway to perform precise visual search and laser pointing tasks. We tested if young adults could reduce even more postural and/or center of pressure sway to succeed in both tasks simultaneously. The methodology is novel because published pointing tasks usually require continuously looking at the pointed target and not exploring an image while pointing elsewhere at the same time. Twenty-five healthy young adults (23.2 ± 2.5 years) performed six visual tasks. In the free-viewing task, participants randomly explored images with no goal. In two visual search tasks, participants searched to locate objects (easy search task) or graphical details (hard search task). Participants additionally pointed a laser beam into a central circle (2°) or pointed the laser turned off. Postural sway and center of pressure sway were reduced complementarily – in various variables – to perform the visual search and pointing tasks. Unexpectedly, the pointing task influenced more strongly postural sway and center of pressure sway than the search tasks. Overall, the participants adopted a functional strategy in stabilizing their posture to succeed in the pointing task and also to fully explore images. Therefore, it is possible to inverse the strength of effects found in the literature (usually stronger for the search task) in modulating the experimental methodology. In search tasks more than in free-viewing tasks, participants mostly rotated their eyes and head, and not their full body, to stabilize their posture. These results could have implications for shooting activities, video console games and rehabilitation most particularly.     

Interstimulus Intervals and Sensory Modality Modulate the Impact of a Cognitive Task on Postural Control

The present literature not only reveals the use of a wide variety of cognitive tasks but variability in their interaction with postural control. The question then arises, as to, whether postural control is sensitive to specific features of a cognitive task. The present experiment assessed the impact of cognitive tasks with interstimulus intervals (ISI) of varied duration and sensory modality on postural control in young adults. Seventeen participants (23.71 ± 1.99 years old) were instructed to stand on a force platform while concurrently performing cognitive tasks with ISIs of two and 5 s. The tasks were presented both, auditorily and visually. The visual tasks consisted of counting the total occurrence of a single digit. The auditory tasks consisted of counting the total occurrence of a single letter. Performing the cognitive tasks with an ISI of 2 s resulted only in an increase in the anteroposterior mean power frequency. Presenting the tasks visually also significantly reduced area of 95% confidence ellipse and AP and mediolateral sway variability. These results may suggest that ISIs can modify postural performance by altering the allocation of attentional focus. Also, presenting tasks using a visual sensory modality appears to yield lower postural sway.     

Interacting Constraints and the Emergence of Postural Behavior in ACL-Deficient Subjects

In this study, the authors examined how task, informational, and sensorimotor system constraints influence postural control. Postural behavior of subjects with (n = 15) and without (n = 15) a key sensorimotor system constraint, anterior cruciate ligaments (ACLs) in 1 knee, was examined during 1- and 2-legged stance with and without vision. Postural control was assessed on a commonly used postural sway meter and on a dynamic stabilometer. Data on postural sway characteristics were obtained for 30 s under 6 different conditions: standing, with eyes open and closed, on both legs, on the injured leg, and on the noninjured leg. The interaction of task, informational, and sensorimotor constraints was observed only on the dynamic stabilometer and not the postural sway meter. Vision was the most important informational constraint on postural control for subjects on the dynamic stabilometer, particularly for the ACL-deficient group standing on the injured leg. Under more static task constraints, ACL deficiency did not prove a significant disadvantage, because vision was confirmed as a significant source of exproprioceptive information. The results support the functionality of using dynamic tasks such as a stabilometer in assessing postural behavior of subjects with sensorimotor system constraints.     

Articulatory constraints on interpersonal postural coordination

Cooperative conversation has been shown to foster interpersonal postural coordination. The authors investigated whether such coordination is mediated by the influence of articulation on postural sway. In Experiment 1, talkers produced words in synchrony or in alternation, as the authors varied speaking rate and word similarity. Greater shared postural activity was found for the faster speaking rate. In Experiment 2, the authors demonstrated that shared postural activity also increases when individuals speak the same words or speak words that have similar stress patterns. However, this increase in shared postural activity is present only when participants' data are compared with those of their partner, who was present during the task, but not when compared with the data of a member of a different pair speaking the same word sequences as those of the original partner. The authors' findings suggest that interpersonal postural coordination observed during conversation is mediated by convergent speaking patterns.     

Interacting Constraints and the Emergence of Postural Behavior in ACL-Deficient Subjects

In this study, the authors examined how task, informational, and sensorimotor system constraints influence postural control. Postural behavior of subjects with (n = 15) and without (n = 15) a key sensorimotor system constraint, anterior cruciate ligaments (ACLs) in 1 knee, was examined during 1 - and 2-legged stance with and without vision. Postural control was assessed on a commonly used postural sway meter and on a dynamic stabilometer. Data on postural sway characteristics were obtained for 30 s under 6 different conditions: standing, with eyes open and closed, on both legs, on the injured leg, and on the noninjured leg. The interaction of task, informational, and sensorimotor constraints was observed only on the dynamic stabilometer and not the postural sway meter. Vision was the most important informational constraint on postural control for subjects on the dynamic stabilometer, particularly for the ACL-deficient group standing on the injured leg. Under more static task constraints, ACL deficiency did not prove a significant disadvantage, because vision was confirmed as a significant source of exproprioceptive information. The results support the functionality of using dynamic tasks such as a stabilometer in assessing postural behavior of subjects with sensorimotor system constraints.