Mechanisms of postural control in older adults based on surface electromyography data

ObjectivesThe present study aimed to clarify the mechanisms of postural control during standing in older adults and document the mechanisms of age-related motor control based on changes in muscle activities.MethodsA total of 26 healthy male adults (older adult group, ≥65–78 years: n = 16; younger adult group, 20–23 years: n = 10) participated in this study. Ground reaction force and kinematic data of the lower limbs (hip, knee, and ankle), and electromyographic data from 6 postural muscles on the right side were recorded and quantified for each motor phase during rapid voluntary center of pressure (COP) shift.ResultsAlthough hip strategy was more frequently observed in older adults than in young adults (56.3% vs. 20.0%), no muscle activity of hip agonists was observed in some (31.3%) older adults. Furthermore, older adults had a statistically significant delay in the inhibition of postural muscles during anticipatory postural adjustments (p < 0.05). After the onset of COP motion, the co-contraction time between agonists and antagonists was significantly prolonged in the older adults than in the younger adults (p < 0.05), and the reciprocal muscle pattern was unclear in the older adults. Prior to the termination of movement, agonist activity continued longer in the older adult group than in the younger adult group; that is, inhibition was insufficient in the older adult group.ConclusionA series of postural strategies during the voluntary movement task were altered in older adults, and this was significantly related not only with the activation but also the inhibition of postural muscles.     

The influence of age,anxiety and concern about falling on postural sway when standing at an elevated level

Psychological processes may influence balance and contribute to the risk of falls in older people. While a self-reported fear of falling is associated with increased postural sway, inducing fear using an elevated platform can lead to reduced sway, suggesting different underlying mechanisms whereby fear may influence balance control. This study examined changes in postural sway, muscle activity and physiological measures of arousal while standing on a 65 cm elevated platform, compared to floor level, in young and older adults. The older adults were classified as fall concerned or not fall concerned based on the Falls Efficacy Scale-International and anxious or not anxious based on the Goldberg Anxiety Scale. Fall concern did not affect the physiological and sway response to the elevated platform. In response to the postural threat, the anxious participants increased their sway frequency (p = 0.001) but did not reduce sway range (p = 0.674). Conversely, non-anxious participants showed an adaptive tightening of balance control, effectively reducing sway range in the elevated condition (p < 0.001). Generalised anxiety in older adults appears to differentially affect postural control strategies under threatening conditions.     

Age-related changes in trunk neuromuscular activation patterns during a controlled functional transfer task include amplitude and temporal synergies

While healthy aging is associated with physiological changes that can impair control of trunk motion, few studies examine how spinal muscle responses change with increasing age. This study examined whether older (over 65 years) compared to younger (20–45 years) adults had higher overall amplitude and altered temporal recruitment patterns of trunk musculature when performing a functional transfer task. Surface electromyograms from twelve bilateral trunk muscle (24) sites were analyzed using principal component analysis, extracting amplitude and temporal features (PCs) from electromyographic waveforms. Two PCs explained 96% of the waveform variance. Three factor ANOVA models tested main effects (group, muscle and reach) and interactions for PC scores. Significant (p < .0125) group interactions were found for all PC scores. Post hoc analysis revealed that relative to younger adults, older adults recruited higher agonist and antagonistic activity, demonstrated continuous activation levels in specific muscle sites despite changing external moments, and had altered temporal synergies within abdominal and back musculature. In summary both older and younger adults recruit highly organized activation patterns in response to changing external moments. Differences in temporal trunk musculature recruitment patterns suggest that older adults experience different dynamic spinal stiffness and loading compared to younger adults during a functional lifting task.     

Effects of age,speed, and step length on lower extremity net joint moments and powers during walking

During walking older adults' gait is slower, they take shorter steps, and rely less on ankle and more on knee and hip joint moments and powers compared to young adults. Previous studies have suggested that walking speed and step length are confounds that affect joint moments and powers. Our purpose was to examine the effects of walking speed and step length manipulation on net joint moments and powers in young and older adults. Sixteen young and 18 older adults completed walking trials at three speeds under three step length conditions as marker position and force platform data were captured synchronously. Net joint moments were quantified using inverse dynamics and were subsequently used to compute net joint powers. Average extensor moments at each joint during the stance phase were then computed. Older adults displayed greater knee extensor moment compared to young adults. Older adults showed trends (p < .10) of having lower ankle and higher hip moments, but these differences were not statistically significant. Average ankle, knee, and hip extensor moments increased with speed and step length. At the fast speed, older compared to young adults generated lower average ankle power (p = .003) and showed a trend (p = .056) of exerting less average moment at the ankle joint. Age-associated distal-to-proximal redistribution of net joint moments was diminished and not statistically significant when the confounding effects of walking speed and relative step length were controlled. These findings imply that age-related distal-to-proximal redistribution of joint moments may influence the different speeds and step lengths chosen by young and older adults.     

Understanding action control of resistance training among adults

BackgroundRegular muscle and bone strengthening activities through resistance training (RT) have been associated with numerous health benefits, particularly as adults age, yet participation is low. Effective promotion is likely founded on an understanding of theory-based correlates, yet almost all RT research has focused on college-aged convenience samples and employed social cognition models, which do not consider the intention-behavior gap. The purpose of this study was to explore RT from the perspective of the multi-process action control (M-PAC) framework in a large Canadian adult sample.MethodCanadian adults (N = 1338) completed M-PAC measures of reflective (instrumental attitude, affective attitude, perceived capability and opportunity), regulatory (planning and self-monitoring), and reflexive (habit, identity) processes as well as intention to engage in RT at baseline and RT behavior two-weeks later.ResultsThree intention-behavior profiles emerged: a) non-intenders who were not active (41.4%), b) unsuccessful intenders who failed to enact their positive intentions (32.9%), and c) successful intenders who engaged in RT (23.5%). A discriminant function analysis (p < .01) showed that instrumental and affective attitude, perceived opportunity and planning/self-monitoring distinguished between all three intention-behavior profiles, while perceived capability predicted the intention-RT profiles of females but not males (p < .01). By comparison, identity was particularly important to younger/middle-aged adults than older females (p < .01), while habit was associated with the intention-RT profiles of older adults but not younger/middle-aged adults (p < .01).ConclusionsThe findings support the importance of considering both intention formation and translation in RT. Behavior change techniques aimed at reflective, regulatory, and reflexive processes appear necessary. Additional considerations of targeting specific constructs by age and sex may maximize the potential effectiveness of RT interventions.     

Making sense of age-related distractibility: The critical role of sensory modality

Older adults are known to have reduced inhibitory control and therefore to be more distractible than young adults. Recently, we have proposed that sensory modality plays a crucial role in age-related distractibility. In this study, we examined age differences in vulnerability to unimodal and cross-modal visual and auditory distraction. A group of 24 younger (mean age = 21.7 years) and 22 older adults (mean age = 65.4 years) performed visual and auditory n-back tasks while ignoring visual and auditory distraction. Whereas reaction time data indicated that both young and older adults are particularly affected by unimodal distraction, accuracy data revealed that older adults, but not younger adults, are vulnerable to cross-modal visual distraction. These results support the notion that age-related distractibility is modality dependent.     

Reorganised anticipatory postural adjustments due to experimental lower extremity muscle pain

Automated movements adjusting postural control may be hampered during musculoskeletal pain leaving a risk of incomplete control of balance. This study investigated the effect of experimental muscle pain on anticipatory postural adjustments by reaction task movements. While standing, nine healthy males performed two reaction time tasks (shoulder flexion of dominant side and bilateral heel lift) before, during and after experimental muscle pain. On two different days experimental pain was induced in the m. vastus medialis (VM) or the m. tibialis anterior (TA) of the dominant side by injections of hypertonic saline (1 ml, 5.8%). Isotonic saline (1 ml, 0.9%) was used as control injection. Electromyography (EMG) was recorded from 13 muscles. EMG onset, EMG amplitude, and kinematic parameters (shoulder and ankle joint) were extracted. During shoulder flexion and VM pain the onset of the ipsilateral biceps femoris was significantly faster than baseline and post injection sessions. During heels lift in the VM and TA pain conditions the onset of the contralateral TA was significantly faster than baseline and post injection sessions in bilateral side. VM pain significantly reduced m. quadriceps femoris activity and TA pain significantly reduced ipsilateral VM activity and TA activity during bilateral heel lift. The EMG reaction time was delayed in bilateral soleus muscles during heels lift with VM and TA pain. The faster onset of postural muscle activity during anticipatory postural adjustments may suggest a compensatory function to maintain postural control whereas the reduced postural muscle activity during APAs may indicate a pain adaptation strategy to avoid secondary damage.     

Exploring how arm movement moderates the effect of task difficulty on balance performance in young and older adults

Emerging evidence highlights that arm movements exert a substantial and functionally relevant contribution on quiet standing balance control in young adults. Ageing is associated with “non-functional” compensatory postural control strategies (i.e., lower limb co-contraction), which in turn, may increase the reliance on an upper body strategy to control upright stance. Thus, the primary purpose of this study was to compare the effects of free versus restricted arm movements on balance performance in young and older adults, during tasks of different difficulty. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and fifteen older (mean ± SD age; 73.3 ± 5.0 years) adults performed bipedal, semi-tandem and tandem balance tasks under two arm position conditions: restricted arm movements and free arm movements. Centre of pressure (COP) amplitude and frequency were calculated as indices of postural performance and strategy, respectively. Especially in older adults, restriction of arm movement resulted in increased sway amplitude and frequency, which was primarily observed for the mediolateral direction. Further, increasing balance task difficulty raised the arm restriction cost (ARC; a new measure to quantify free vs. restricted arm movement differences in postural control) that was more prominent in older adults. These findings indicate the ARC provides a measure of reliance on the upper body for balance control and that arm movement is important for postural control in older adults, especially during tasks of greater difficulty.     

The effects of perturbation type and direction on threat-related changes in anticipatory postural control

The purpose of this study was to determine whether the type and direction of postural perturbation threat differentially affect anticipatory postural control. Healthy young adults stood on a force plate fixed to a translating platform and completed a series of rise-to-toes movements without (No Threat) and with (Threat) the potential of receiving a postural perturbation to either their feet (15 participants) or torso (16 participants). Each type of perturbation threat was presented along the anteroposterior (A-P) or mediolateral (M-L) axis. For each condition, the A-P center of pressure (COP) signal and tibialis anterior (TA) and soleus (SOL) electromyographical (EMG) recordings were used to quantify the anticipatory postural adjustment (APA). Results indicated that across both threat types and directions, postural threat induced a 40.2% greater TA activation (p < 0.001), a 18.5% greater backward COP displacement (p < 0.001) and a 23.9% greater backward COP velocity (p < 0.001), leading to larger and faster APAs than the No Threat condition. Subsequently, a 7.7% larger forward COP displacement (p = 0.001), a 20.4% greater forward COP velocity (p < 0.001) and 43.2% greater SOL activation (p = 0.009) were observed during the execution phase of the rise-to-toes for the Threat compared to the No Threat condition. Despite these threat effects, there were no differences in the magnitude or velocity of APAs between the threat directsion conditions. Since the type and direction of perturbation-induced postural threat had minimal differential effects on anticipatory postural control, these factors are unlikely to explain the discrepancy of previous findings.     

Short-term and long-term collaboration benefits on individual recall in younger and older adults

A recent study of younger adults suggests that, compared to repeated individual recall trials, repeated collaborative recall trials produce better individual recall after a short delay (Blumen & Rajaram, 2008). Our study was designed to determine if such collaboration benefits would remain after a one-week delay, in both younger and older adults. Sixty younger (M age = 24.60) and 60 older (M age = 67.35) adults studied a list of words and then completed either two collaborative recall trials followed by two individual recall trials, or four individual recall trials. A five-min delay was inserted between the first three recall trials. The fourth recall trial was administered 1 week later. Collaborative recall was completed in groups of three individuals working together. Both younger and older adults benefitted from repeated collaborative recall trials to a greater extent than repeated individual recall trials, and such collaboration benefits remained after a one-week delay. This is the first demonstration of collaboration benefits on later individual recall at delays as long as 1 week, in both younger and older adults. Findings are discussed within the context of the negative effects of collaboration associated with group memory (collaborative inhibition) and the positive effects of collaboration associated with later individual memory (collaboration benefits).     

Effects of age simulation and age on motor sequence learning: Interaction of age-related cognitive and motor decline

Aging is known to lead to decrements in sensory and cognitive functioning and motor performance. The purpose of the present experiment was twofold: a) We assessed the influence of wearing an age simulation suit on motor sequence learning, cognitive speed tasks and far visual acuity in healthy, younger adults. b) We evaluated the interaction of cognitive aging and declining motor sequence learning in older adults. In a between-subjects design we tested 11 younger adults (M_age = 23.6 years) without the age suit, 12 younger adults wearing the age suit (M_age = 23.2 years), and 23 older adults (M_age = 72.6 years). All participants learned a simple, spatial-temporal movement sequence on two consecutive days, and we assessed perceptual processing speed (Digit Symbol Substitution test and Figural Speed test) and far visual acuity. Wearing an age simulation suit neither affected the learning of the simple motor sequence nor the performance at the cognitive speed tasks in younger adults. However, far visual acuity suffered from wearing the suit. Younger adults with and without the suit showed better motor sequence learning compared to older adults. The significant correlations between the cognitive speed tests and the motor learning performance in older adults indicated that cognitive aging partially explains some of the variance in age-related motor learning deficits.     

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.     

The effect of trunk flexion angle on lower limb mechanics during running

Trunk flexion is an understudied biomechanical variable that potentially influences running performance and susceptibility to injury. We present and test a theoretical model relating trunk flexion angle to stride parameters, joint moments and ground reaction forces that have been implicated in repetitive stress injuries. Twenty-three participants (12 male, 11 female) ran at preferred trunk flexion and three more flexed trunk positions (moderate, intermediate and high) on a custom built Bertec™ instrumented treadmill while kinematic and kinetic data were simultaneously captured. Markers adhered to bony landmarks tracked the movement of the trunk and lower limb. Stride parameters, moments of force and ground reaction force were calculated using Visual 3D (C-Motion ©) software. From preferred to high trunk flexion, stride length decreased 6% (P < 0.001) and stride frequency increased 7% (P < 0.001). Extensor moments at the hip increased 70% (P < 0.001), but knee extensor (P < 0.001) and ankle plantarflexor moments (P < 0.001) decreased 22% and 14%, respectively. Greater trunk flexion increased rate of loading by 29% (P < 0.01) and vertical ground reaction force impact transients by 20% (P < 0.01). Trunk flexion angle during running has significant effects on stride kinematics, lower extremity joint moments and ground reaction force and should be further investigated in relation to running performance and repetitive stress injuries.     

Ankle kinetics and plantarflexor morphology in older runners with different lifetime running exposures

Running promotes better cardiovascular health and has positive effects on the musculoskeletal system in older adults. However, older adults have lower ankle plantarflexor torques and positive powers during running, and exhibit changes in plantarflexor morphology than young adults. Since older runners who run as much as younger runners exhibit youthful ankle mechanical outputs, running exposure may preserve the locomotor factors that mediate running speed. The purpose of this study was to compare ankle mechanical output during running and plantarflexor morphological characteristics between older runners who have low or high lifetime running exposure. Ten older runners with low lifetime running exposure and nine older runners with high lifetime running exposure performed over-ground running trials at 3.0 m/s (±5%) while kinematic and ground reaction force (GRF) data were collected and used to compute joint angular kinetics. Right medial gastrocnemius morphological characteristics were assessed using ultrasonography at rest and during isometric contractions. Ankle torques, powers, and plantarflexor morphology were compared between groups. Older runners with different lifetime running exposures ran with similar ankle mechanical output (i.e. no effect of running exposure) (p > .05) and exhibited similar medial gastrocnemius morphology during isometric testing. The findings from this study demonstrate that lifetime running exposure does not appear to influence ankle mechanical output or plantarflexor morphology in middle-aged runners.     

Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy

The aim of this study was to examine postural control in children with cerebral palsy performing a bilateral shoulder flexion to grasp a ball from a sitting posture. The participants were 12 typically developing children (control) without cerebral palsy and 12 children with cerebral palsy (CP). We analyzed the effect of ball mass (1 kg and 0.18 kg), postural adjustment (anticipatory, APA, and compensatory, CPA), and groups (control and CP) on the electrical activity of shoulder and trunk muscles with surface electromyography (EMG). Greater mean iEMG was seen in CPA, with heavy ball, and for posterior trunk muscles (p < .05). The children with CP presented the highest EMG and level of co-activation (p < .05). Linear regression indicated a positive relationship between EMG and aging for the control group, whereas that relationship was negative for participants with CP. We suggest that the main postural control strategy in children is based on corrections after the beginning of the movement. The linear relationship between EMG and aging suggests that postural control development is affected by central nervous disease which may lead to an increase in muscle co-activation.     

The effect of shoe and floor characteristics on walking kinematics

It is common sense that walking on sand poses challenges to postural control. However, there are no studies quantifying the kinematics of sand walking compared to other types of postural perturbations such as unstable shoes. The aim of the study was to investigate differences in walking kinematics during walking on solid ground, in unstable shoes and on unstable surfaces. Nineteen healthy young adults (23.5 ± 1.5 years) performed three different walking tasks: 1) walking at preferred speed while wearing regular shoes; 2) Walking at preferred speed wearing Masai Barefoot Technology shoes and 3) barefoot walking at preferred speed on a large sand grave. Full-body kinematics were recorded during all conditions using an inertial motion capture system. Basic gait parameters (walking speed, stride length and duration), relative vertical center-of-mass position (rvCOM), and ankle, knee and hip joint angles in the sagittal plane were compared across the tasks through statistical parametric mapping over the course of full walking cycles. Participants presented similar walking speed, as well as stride length and duration across different conditions (p > 0.05). However, walking on sand reduced the rvCOM (p < 0.05), while also requiring greater ankle plantarflexion during stance phase (p < 0.05), as well as greater knee and hip flexion during leg swing and initial contact when compared to the other conditions (p < 0.05). It was concluded that walking on sand substantially changes walking kinematics, and may cause greater postural instability than unstable shoes. Therefore, walking on sand can be an alternative to improve postural control in patients undergoing walking rehabilitation.     

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.     

Task demand effects on postural control in older adults

The literature shows conflicting results regarding older adults' (OA) postural control performance. Differing task demands amongst scientific studies may contribute to such ambiguous results. Therefore, the purpose of this study was to examine the performance of postural control in older adults and the relationship between visual information and body sway as a function of task demands. Old and young adults (YA) maintained an upright stance on different bases of support (normal, tandem and reduced), both with and without vision, and both with and without room movement. In the more demanding tasks, the older adults displayed greater body sway than the younger adults and older adults were more influenced by the manipulation of the visual information due to the room movement. However, in the normal support condition, the influence of the moving room was similar for the two groups. These results suggest that task demand is an important aspect to consider when examining postural control in older adults.     

Postural stability with exhaustive repetitive sit-to-stand exercise in young adults

Previous research has indicated that muscle fatigue due to repeated bouts of physical activity can have negative residual effects on balance; however investigations using multi-joint forms of exercise involved in everyday settings and determination of how control of posture is altered during the physical activity itself are limited. The purpose of this investigation was to evaluate alterations in postural stability before, during, and after prolonged multi-joint STS exercise in healthy young adults. Center of pressure (COP) acquisitions were collected during repetitive STS exercise, while voluntary limits of stability (LOS) testing was performed before, immediately after, and 10 min after STS exercise. By 50% total STS exercise time, fatigue resulted in increased anterio-posterior (y) and medio-lateral (x) COP path lengths (p = 0.003 and p = 0.018 respectively) and an anterior shift of COP at seat-off towards the mid-foot (p = 0.010). No significant change in LOS mean amplitude was found after STS exercise; however a significant fatigue effect resulted in increased COPy sway velocity at maximal lean positions (p = 0.006), but returned to PRE values after 10 min of rest. Declines in postural stability during repetitive STS exercise was associated with reduced control of COP, as well as a reduced ability to stably control COP at extreme postural limits; however, 10 min was adequate in young adults for recovery. These results may have important implications for monitoring fall risk due to acute bouts of exercise induced muscle fatigue from repetitive multi-joint activities such as the STS.     

Effect of different residential settings on gait kinematic parameters in older adults with cognitive impairment

ObjectiveTo compare the parameters of gait kinematics of older adults with cognitive impairment who live in community dwellings or those living or spending most of the time in non-family environment settings.MethodsThe sample was composed of 33 older adults of both sexes with cognitive impairment. Participants were separated into three groups: a community-dwelling older adult group comprised of 11 subjects; a semi-institutionalized older adult group comprised of 10 older adults attended in a geriatric daycare institution; and an institutionalized older adult group comprised of 12 older adults living in long-term institutions. Gait kinematics were recorded by pressure sensors (footswitches). Fifty gait cycles at self-selected pace were analyzed to obtain: gait speed, stride length, stance, swing, and stride time. The variability of these parameters was also analyzed.ResultsMANCOVA identified the main effect of groups (p < 0.001). Gait speed of older adults living in long-term institutions and older adults attended in geriatric daycare institutions was slower than community-living older adults (p < 0.001 and p = 0.04, respectively). Swing and stride time variability was higher in older adults living in long-term institutions (p = 0.003 and p = 0.001) and in older adults attended in geriatric daycare institutions (p = 0.02 and p = 0.001) than in community-dwelling older adults.ConclusionThe most important finding was that older adults with cognitive impairment who need non-family residential setting care had higher gait kinematics abnormalities, which may increase the risk of falls, compared to those who live in the community.