Effects of sensory manipulations on the dynamical structure of center-of-pressure trajectories of children with cerebral palsy during sitting

Aim: To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting. Methods: 32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam. Results: Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories. Conclusion: Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.     

How do children aged 6 to 11 stabilize themselves on an unstable sitting device? The progressive development of axial segment control

Postural control continues to develop during middle childhood as shown by the decrease in body sway in stance between the ages of 5 and 11. Although head and trunk control is crucial for balance control during both static and dynamic activities, evaluating its specific development and its contribution to overall postural control is methodologically challenging. Here, we used an unstable sitting device adapted to ensure that only the axial segments could control the balance of the device and thus the balance of the upper body. This study aimed to assess the development of the postural stabilization of axial body segments during middle childhood. Thirty-six children (in three age groups: 6-7yo, 8-9yo, and 10-11yo) and 11 adults sat on the unstable sitting device and had to stabilize their axial segments under several conditions: a moderate vs. high level of balance challenge, and eyes open vs. eyes closed. Upper-body postural sway (area, mean velocity and root mean square (RMS) of the center of pressure (CoP) displacement) decreased progressively with age (6-7yo > 8-9yo > 10-11yo > adults), and this effect was accentuated when the balance challenge was high (for CoP area) or in the “eyes closed” condition (for CoP area and RMS). The stabilization strategies were assessed by anchoring indexes computed from three-dimensional kinematics. A progressive shift was showed, from an “en bloc” pattern at 6–7 years of age toward a more articulated (i.e. adult-like) pattern at 10–11. A head-on-space stabilization strategy first emerged at the age of 8–9. Middle childhood is an important period for the development of axial segment stabilization, which continues to mature until adulthood. This development might be related to the introduction and progressive mastery of feedforward sensorimotor processes and might contribute strongly to the development of overall postural control.     

Effects of Visual Manipulation in Sit-to-Stand Movement in Children With Cerebral Palsy

The authors sought to verify the effects of vision on sit-to-stand (STS) movement performance by means of postural sway in children with cerebral palsy (CP) and typical children (TC). Participants were 42 TC and 21 children with CP. STS movement was assessed with eyes open and with eyes closed. Area and velocity of center of pressure sway were analyzed in each of the 3 STS phases. We observed greater postural sway during STS movement with eyes closed. Children with CP presented greater postural sway than TC did. Both groups exhibited greater postural instability with absence of vision expressing the role of vision to keep postural stability. Moreover, the greater postural instability was observed in children with CP.     

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.     

Postural orientation: age-related changes in variability and time-to-boundary

The relation between age-specific postural instability and the detection of stability boundaries was examined. Balance control was investigated under different visual conditions (eyes open/closed) and postural orientations (forward/backward lean) while standing on a force platform. Dependent variables included center of pressure variability and the time-to-contact of the center of pressure with the stability boundaries around the feet (i.e., time-to-boundary). While leaning maximally, older individuals (ages 55-69) showed increased center of pressure variability compared to no lean, while younger subjects (ages 24-38) showed a decrease. These significant differences were found only in anterior-posterior direction. No significant age-specific differences were found between eyes open and eyes closed conditions. Time-to-boundary analysis revealed reduced spatio-temporal stability margins in older individuals in both anterior-posterior and medio-lateral directions. Time-to-boundary variability, however, was not significantly different between the groups in both medio-lateral and anterior-posterior direction. These results show the importance of boundary relevant center of pressure measures in the study of postural control, especially concerning the lateral instability often observed in older adults.     

Effects of visual and auditory short-term memory tasks on the spatiotemporal dynamics and variability of postural sway

The authors measured postural sway while participants (N = 20 in each experiment) stood on a rigid or a compliant surface, with their eyes open or closed, and while they did or did not perform a short-term memory (STM) task. In Experiment 1, the STM stimuli were presented visually; in Experiment 2, the stimuli were presented auditorily. In both experiments, fine-scaled, mediolateral postural-sway variability decreased as the cognitive load imposed by the STM task increased. That effect was independent of support surface and vision manipulations. The spatiotemporal profile of postural sway was affected by both visual and auditory STM tasks, but to a greater degree by the auditory task. The authors discuss implications of the results for theories and models of postural control.     

Dynamics of postural control during bilateral stance – Effect of support area,visual input and age

The present study investigated the effect of support area, visual input and aging of the dynamics of postural control during bilateral stance. Fifteen young (22.1 ± 1.7 years) and fifteen older (68.3 ± 2.7 years) individuals completed four different 90 s bilateral stance trials: 1) shoulder wide feet distance with eyes open, 2) shoulder wide feet distance with eyes closed, 3) narrow feet distance with eyes open, and 4) narrow feet distance with eyes closed on a force plate form. The anterior (AP) and mediolateral (ML) center of pressure (COP) trajectories were calculated from the middle 60 s of the ground reaction forces and moments. Sample entropy (SaEn), correlation dimension (CoD), the largest Lyapunov exponent (LyE) and entropic half-life (ENT½) were calculated for the COP in both directions. In young individuals, a narrower support area resulted in a restricted movement solution space with lower SaEn, lower LyE and longer ENT½ in the executed motor control strategy, whereas it increased the CoD in the older individuals. During the eyes closed trials, SaEn, CoD and LyE increased and decreased ENT½ for both groups in the AP direction and increased SaEn and LyE in the ML direction for the older individuals alone. This indicates that aging is associated with direction- and task-dependent changes in the dynamics of the executed COP movements during postural stance tasks.     

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.     

Two steps forward and one back: Learning to walk affects infants' sitting posture

The transition from sitting to walking is a major motor milestone for the developing postural system. This study examined whether this transition to walking impacts the previously established posture (i.e., sitting). Nine infants were examined monthly from sitting onset until 9 months post-walking. Infants sat on a saddle-shape chair either independently or with their right hand touching a stationary contact surface. Postural sway was measured by sway amplitude, variability, area, and velocity of the center of pressure trajectory. The results showed that for all the postural measures in the no-touch condition, a peak before or at walk onset was observed in all the infants. At the transition age, when peak sway occurred, infants' postural sway measures were significantly greater than at any other age. Further, infants' postural sway was attenuated by touch only at this transition. We suggest that this transient disruption in sitting posture results from a process involving re-calibration of an internal model for the sensorimotor control of posture so as to accommodate the newly emerging bipedal behavior of independent walking.     

Two-dimensional Langevin approach to the human stabilogram

Two-dimensional Langevin equation is considered as a model of the center of pressure (COP) random walk at quiet standing condition. The matrix of the mean square displacement describes quantitatively the COP random walk. Twenty-six young subjects were included in the study. Elements of the matrix of the mean square displacement derived from experimental data are well approximated by theoretical expressions derived from the Langevin equation, in the short-term regime. We have studied statistical properties of the COP displacements. Non-Gaussian behaviour of the displacements is indicated by the characteristic functions. New coordinate system constituted and utilised by the postural control system (PCS) was found for every subject. This new coordinate system is turned with respect to the system defined by the anatomy of the body. In this new coordinate system the matrix of the mean square displacement takes the form close to diagonal. The status of PCS in this new coordinate system can be quantified by the elements of the diffusion matrix, which are the measure of the stochastic activity of that system, rotation angle of new coordinate system and the friction coefficient. We have applied this analysis to examine how the visual inputs affect the PCS. We have found that the stochastic activity of the PCS increases after exclusion of the visual inputs. We have also shown that the visual system does not affect the friction coefficient. Furthermore, we have found that orientation of the new coordinate system chosen by PCS at included visual inputs differs from the orientation at excluded visual inputs.     

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.     

The functional role of central and peripheral vision in the control of posture

Three experiments were conducted to investigate the role of central and peripheral vision (CV and PV) in postural control. In Experiment 1, either the central or peripheral visual field were selectively stimulated using a circular random dot pattern that was either static or alternated at 5 Hz. Center of foot pressure (CoP) was used to examine postural sway during quiet standing under both CV and PV conditions. The results showed that, when the visual stimulus was presented in the periphery, the CoP area decreased and more so in the anterior-posterior (AP) than in the medio-lateral (ML) direction, indicating a characteristic directional specificity. There was no significant difference between the static and dynamic (alternating) conditions. Experiment 2 investigated the directional specificity of body sway found in Experiment 1 by having the trunk either be faced toward the stimulus display or perpendicularly to it, with the head always facing the display. The results showed that the stabilizing effect of peripheral vision was present in the direction of stimulus observation (i.e., the head/gaze direction), irrespective of trunk orientation. This suggested that head/gaze direction toward the stimulus presentation, rather than a biomechanical factor like greater mobility of the ankle joint in AP direction than in ML direction, was essential to postural stability. Experiment 3 further examined whether the stabilizing effect of peripheral vision found in Experiments 1 and 2 was caused because more dots (500) were presented as visual cues to the peripheral visual field than to the central visual field (20 dots) by presenting the same number of dots (20) in both conditions. It was found that, in spite of the equal number of dots, the postural sway amplitudes were larger for the central vision conditions than for the peripheral vision conditions. In conclusion, the present study showed that peripheral rather than central vision contributes to maintaining a stable standing posture, with postural sway being influenced more in the direction of stimulus observation, or head/gaze direction, than in the direction of trunk orientation, which suggests that peripheral vision operates primarily in a viewer-centered frame of reference characterized by the head/gaze direction rather than in a body-centered frame of reference characterized by the anatomical planes of the body.     

Transient Effects of Gaze Stability Exercises on Postural Stability in Patients With Posterior Circulation Stroke

The authors sought to investigate if short-term gaze stability exercises have an effect on postural stability of dynamic standing during neck movement in patients with posterior circulation stroke (PCS). Patients in both PCS and non-PCS groups were assigned to either an intervention or control group. The intervention group performed the gaze stability exercises for 10 min while the control group was merely resting. The center of pressure velocity was calculated to evaluate the postural stability. After intervention, PCS and non-PCS showed a significant reduction in center of pressure velocity during dynamic standing with eyes closed condition, and the PCS group showed a significant improvement in eye-opened condition. This study indicated that gaze stability exercises improve PCS patients' postural control, especially during dynamic standing.     

Diminished plantar cutaneous sensation and postural control

The purpose of this study was to assess the effect of diminished plantar cutaneous sensation induced by cooling on postural control during double- and single-limb quiet standing. 32 healthy adults were tested on an intervention day and control day. The intervention consisted of 10 min. of ice immersion of the plantar aspect of the feet prior to balance testing. Dependent variables were center of pressure velocity and area during double- and single-limb stance with eyes open and closed. Significant interactions were found between sensation and vision for double-limb center of pressure area, with a significant reduction in area of center of pressure excursions after reducing sensation with eyes closed but not with eyes open. The area of center of pressure excursions may have been reduced in an effort to curtail exploratory postural behavior given the altered afferent input from plantar receptors. There were no significant differences for plantar hypoesthesia in single-limb stance.     

Are postural adjustments during reaching related to walking development in typically developing infants and infants at risk of cerebral palsy?

BackgroundIn typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk.MethodsTen typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated.ResultsIn both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants.ConclusionIncreasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit.     

Postural control after unexpected external perturbation: Effects of Parkinson’s disease subtype

Different clinical subtypes of Parkinson’s disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0–200 ms and 200–700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes.     

Postural Asymmetries in Response to Holding Evenly and Unevenly Distributed Loads During Self-Selected Stance

The authors examined postural asymmetries during quiet stance and while holding evenly or unevenly distributed loads. Right-hand dominant subjects preferentially loaded their right lower limb when holding no load or a load evenly distributed in both hands, but no differences in center of pressure (CoP) were observed between the left and right limbs. However, longer CoP displacement was observed under the preferentially loaded limb, which may reflect a functional asymmetry that allows quick movement of one limb in response to a potential perturbation. When a load was held only in the nondominant hand, sample entropy decreased in the left (loaded) limb but increased in the right (unloaded) limb, suggesting the unloaded foot compensated for a loss of control flexibility in the loaded foot.     

Postural asymmetries in response to holding evenly and unevenly distributed loads during self-selected stance

The authors examined postural asymmetries during quiet stance and while holding evenly or unevenly distributed loads. Right-hand dominant subjects preferentially loaded their right lower limb when holding no load or a load evenly distributed in both hands, but no differences in center of pressure (CoP) were observed between the left and right limbs. However, longer CoP displacement was observed under the preferentially loaded limb, which may reflect a functional asymmetry that allows quick movement of one limb in response to a potential perturbation. When a load was held only in the nondominant hand, sample entropy decreased in the left (loaded) limb but increased in the right (unloaded) limb, suggesting the unloaded foot compensated for a loss of control flexibility in the loaded foot.     

Multisensory postural control in adults: Variation in visual,haptic, and proprioceptive inputs

Maintaining balance is fundamentally a multisensory process, with visual, haptic, and proprioceptive information all playing an important role in postural control. The current project examined the interaction between such sensory inputs, manipulating visual (presence versus absence), haptic (presence versus absence of contact with a stable or unstable finger support surface), and proprioceptive (varying stance widths, including shoulder width stance, Chaplin [heels together, feet splayed at approximately 60°] stance, feet together stance, and tandem stance) information. Analyses of mean velocity of the Centre of Pressure (CoP) revealed significant interactions between these factors, with stability gains observed as a function of increasing sensory information (e.g., visual, haptic, visual + haptic), although the nature of these gains was modulated by the proprioceptive information and the reliability of the haptic support surface (i.e., unstable versus stable finger supports). Subsequent analyses on individual difference parameters (e.g., height, leg length, weight, and areas of base of support) revealed that these variables were significantly related to postural measures across experimental conditions. These findings are discussed relative to their implications for multisensory postural control, and with respect to inverted pendulum models of balance. (185 words).     

Spatial and Temporal Adaptations That Accompany Increasing Catching Performance During Learning

During stance, head extension increases postural sway, possibly due to interference with sensory feedback. The sit-to-stand movement is potentially destabilizing due to the development of momentum as the trunk flexes forward and the body transitions to a smaller base of support. It is unclear what role head orientation plays in the postural and movement characteristics of the sit-to-stand transition. The authors assessed how moving from sitting to standing with head-on-trunk extension compared with moving with the head neutral or flexed, or with moving with the head facing forward in space (which would involve head-on-trunk extension, but not head-in-space extension) in healthy, young participants. Head-on-trunk extension increased center of pressure variability, but decreased movement velocities, movement duration, and trunk flexion compared with flexed and neutral head-on-trunk orientations. Similarities in movement characteristics between head-on-trunk extension and the forward head-in-space orientation suggest that stabilizing the head in space does not fully counteract the postural and movement changes due to head-on-trunk extension. Findings suggest that proprioceptive feedback from the neck muscles contributes to the regulation of posture and movement, and therefore should not be overlooked in research on the role of sensory feedback in postural control.