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.     

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.     

Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue

The purpose of this study was to investigate changes in postural sway and strategy elicited by lumbar extensor muscle fatigue. Specifically, changes in center of mass (COM), center of pressure (COP), and joint kinematics during quiet standing were determined, as well as selected cross correlations between these variables that are indicative of movement strategy. Twelve healthy male participants stood quietly both before and after exercises that fatigued the lumbar extensors. Whole-body movement and ground reaction force data were recorded and used to calculate mean body posture and variability of COM, COP, and joint kinematics during quiet standing. Three main findings emerged. First, participants adopted a slight forward lean post-fatigue as evidenced by an anterior shift of the COM and COP. Second, post-fatigue increases in joint angle variability were observed at multiple joints including joints distal to the fatigued musculature. Despite these increases, anterior-posterior (AP) ankle angle correlated well with AP COM position, suggesting the body still behaved similar to an inverted pendulum. Third, global measures of sway based on COM and COP were not necessarily indicative of changes in individual joint kinematics. Thus, in trying to advance our understanding of how localized fatigue affects movement patterns and the postural control system, it appears that joint kinematics and/or multivariate measures of postural sway are necessary.     

Effect of magnetic insoles on postural sway measures in men and women during a static balance test

Numerous anecdotal reports have suggested a growing public enthusiasm for magnetic devices for treatment of pain and various motor and sensory dysfunctions. Although the principles behind magnetic therapy are well documented, a complete technical explanation of whether static magnet application is effective is lacking due to a paucity of scientific research. In this study the effectiveness of magnetic insoles on postural sway measures during a single application were investigated. Twenty-eight adults (14 old, 14 young) were assessed on postural sway measures while performing a static two-legged stance test on a Kistler force platform under two treatment conditions (magnetic insoles, nonmagnetic insoles). Significant reductions in total sway area and lateral sway scores were obtained by the older adults while standing on the magnetic insoles. These preliminary results indicate that treatment of postural instability using magnetic insoles may be a viable alternative for older adults.     

Multifractality in postural sway supports quiet eye training in aiming tasks: A study of golf putting

The ‘quiet eye’ (QE) approach to visually-guided aiming behavior invests fully in perceptual information's potential to organize coordinated action. Sports psychologists refer to QE as the stillness of the eyes during aiming tasks and increasingly into self- and externally-paced tasks. Amidst the ‘noisy’ fluctuations of the athlete's body, quiet eyes might leave fewer saccadic interruptions to the coupling between postural sway and optic flow. Postural sway exhibits fluctuations whose multifractal structure serves as a robust predictor of visual and haptic perceptual responses. Postural sway generates optic flow centered on an individual's eye height. We predicted that perturbing the eye height by attaching wooden blocks below the feet would perturb the putting more so in QE-trained participants than participants trained technically. We also predicted that QE's efficacy and responses to perturbation would depend on multifractality in postural sway. Specifically, we predicted that less multifractality would predict more adaptive responses to the perturbation and higher putting accuracy. Results showed that lower multifractality led to more accurate putts, and the perturbation of eye height led to less accurate putts, particularly for QE-trained participants. Models of radial error (i.e., the distance between the ball's final position and the hole) indicated that lower estimates of multifractality due to nonlinearity coincided with a more adaptive response to the perturbation. These results suggest that reduced multifractality may act in a context-sensitive manner to restrain motoric degrees of freedom to achieve the task goal.     

Body sway during long-term standing and as affected by pure tones

Sixty students, male and female, were used as Ss to test the effect of a 1, 000-Hz, 5-sec tone at 0, 70, and 90 dB, on standing sway. In general, antero-posterior sway was greater than lateral, and males swayed more than females in both directions. In addition, males increased their sway in time, whereas females did not. Only lateral sway in the 5-sec interval after the presentation of the tone increased, and only after 10, 15, and 20 min of standing, with a maximum at 15 min. Amplitude of lateral sway appeared independent of bodily characteristics, and is suggested as being more useful for comparing Ss than is antero-posterior sway.     

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.     

Comparison of power spectrum characteristics of body sway during a static upright standing posture in healthy elderly people and young adults

This study was designed to compare peak frequency, mean power frequency, and power spectrum of each frequency band of body-sway time series and velocity time series power spectra between 30 healthy elderly people and 30 young adults and to clarify their frequency characteristics. Peak frequency and mean power frequency differed between groups, being higher for elderly persons, and the difference was marked in the front-back direction. When comparing power spectra of three domains (A: 0.02-0.2 Hz, B: 0.2-2.0 Hz, and C: 2.0-10.0 Hz) of an international standard, a significant age-group difference was found only in the front-back direction. Young adults were higher in the low frequency band (A domain) in sway time series, and the elderly group was higher in the high frequency band (C domain) in body-sway velocity time series. However, almost all power spectra of both groups appeared in the low frequency band. The present results suggested frequency characteristics of healthy people occur in the low frequency band, but the elderly group compared with the young adults had more characteristics in the high frequency band. Their frequency characteristics cannot be properly evaluated by the international standard established to screen disorders. It may be necessary for healthy people to have new evaluation frequency sections when considering power spectrum characteristics of sway time series and sway-velocity time series.     

Age-related differences in postural reaction time and coordination during voluntary sway movements

The elderly are known to exhibit declines in postural control during standing and walking, however little is known about how the elderly react under time-critical and challenging postural situations. The purpose of this study was to examine age-related differences in reaction time (RT) and the pattern of temporal coordination between center of pressure (COP), trunk and head motion during voluntary postural sway movements. Healthy young (n=10; mean=24 years; SD=5 years) and elderly men (n=8; mean=75 years; SD=2 years) stood on a force plate with tri-axial accelerometers attached to the head and lower trunk. Participants were required to generate sway in the anterior-posterior (AP) or medial-lateral (ML) direction in response to an auditory cue during two different testing conditions called Static reaction and Dynamic reaction. Static reactions involved the initiation of voluntary sway in either the AP or ML direction from quiet stance. Dynamic reactions involved an orthogonal switch of voluntary sway between the AP and ML directions. Compared to the young, elderly individuals exhibited slower RT during both Static and Dynamic reaction, and smaller differences in RT and phasing between COP, trunk, and head motion. The results of this study suggest that the elderly adopted more rigid coordination strategies compared to the young when executing a rapid change in direction of whole body motion. The rigid movement strategy of the elderly was presumably generated in an effort to compensate for increased challenge to the maintenance of stability.     

Influence of prolonged wearing of unstable shoes on upright standing postural control

ObjectiveTo study the influence of prolonged wearing of unstable shoes on standing postural control in prolonged standing workers.MethodsThe participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8 weeks. Stabilometry parameters related to centre of pressure (CoP), rambling (RM) and trembling (TR) as well as the total agonist/antagonist muscle activity, antagonist co-activation and reciprocal activation were evaluated during upright standing, before and after the 8 weeks period. In both moments, the subjects were evaluated wearing the unstable shoes and in barefoot.ResultsThe unstable shoe condition presented increased CoP displacement related variables and decreased co-activation command compared to barefoot before and after the intervention. The prolonged wearing of unstable shoes led to: (1) reduction of medial–lateral CoP root mean square and area; (2) decreased anteroposterior RM displacement; (3) increased anteroposterior RM mean velocity and mediolateral RM displacement; (4) decreased anteroposterior TR RMS; and (5) increased thigh antagonist co-activation in the unstable shoe condition.ConclusionThe unstable shoe condition is associated to a higher destabilising effect that leads to a selection of more efficient and accurate postural commands compared to barefoot. Prolonged wearing of unstable shoes provides increased effectiveness and performance of the postural control system, while wearing of unstable shoes in upright standing, that are reflected by changes in CoP related variables and by a reorganisation of postural control commands.     

Age-stage differences in body sway during a static upright posture based on sway factors and relative accumulation of power frequency

This study was done to examine age-stage (preschool children, young adults, and elderly people) differences in the center-of-pressure sway using body-sway factors (unit-time sway, front-back sway, left-right sway, and high frequency-band power), power-spectrum distribution, and relative accumulation of power frequency (25%, 50%, and 75% RAPF) of the center-of-pressure spectrum. The center-of-pressure movement for 1 min. was measured twice using Anima's stabilometer. Data-sampling frequency was set at 20 Hz. Significant age-stage differences were found for 3 factors except for left-right sway, which was larger for preschool children and elderly than for young adults. The power spectrum of body sway in any age-stage was noted mainly in low frequency bands. A marked age-stage difference was found at 75% RAPF. Body-sway characteristics in each age-stage differ, and differences of postural-sway frequency are marked in the low frequency bands.     

Unveilling the cerebral and sensory contributions to automatic postural control during dual-task standing

ObjectivesThe postural control dual-task literature has demonstrated greater postural stability during dual-task in comparison to single task (i.e., standing balance alone through the examination of multiple kinetic and kinematic measures. This improve stability is thought to reflect an automatic mode of postural control during dual-task. Recently, sample entropy (SampEn) and wavelet discrete transform have supported the claim of automaticity, as higher SampEn values and a shift toward increased contributions from automatic sensory systems have been demonstrated in dual-task settings. In order to understand the cortical component of postural control, functional near-infrared spectroscopy has been used to measure cortical activation during postural control conditions. However, the neural correlates of automatic postural behaviour have yet to be fully investigated. Therefore, the purpose of this study is to confirm the presence of automatic postural control through static and dynamic balance measures, and to investigate the prefrontal cortex activation when concurrently performing quiet standing and the auditory cognitive tasks of varied difficulty.MethodEighteen healthy young adults (21.4 ± 3.96 yo), 12 females and 6 males, with no balance deficits were recruited. Participants were instructed to either quietly stand on a force platform (SM), perform three cognitive tasks while seated (SC) or perform both aforementioned tasks concurrently (DT).ResultsResults supported automatic postural control with lower area and standard deviation of center-of-pressure in DT conditions compared to SM. As for SampEn and the wavelet analysis, DT conditions demonstrated greater values than SM, and a shift from vision to a cerebellar contribution. For the most difficult cognitive task, the DNS task, a trend toward significantly lower right hemisphere prefrontal cortex activation compared to left hemisphere activation in DT was found, potentially representing a decrease in cognitive control, and the presence of automaticity.ConclusionThese findings suggest that the simultaneous performance of a difficult cognitive task and posture yields automatic postural behaviour, and provides insight into the neural correlates of automaticity.     

Dual-task training reduces impact of cognitive task on postural sway

Postural sway increases when a cognitive task is performed concurrently with a postural task. The author examined the hypothesis that following dual-task training, a concurrent cognitive task would not amplify postural sway. Participants (N = 18) were assigned to no-training, single-task training, or dual-task training groups. Single-task training consisted of 3 sessions in which the postural task, quiet standing on a compliant surface, and the cognitive task, counting backward by 3s, were practiced separately. Dual-task training consisted of 3 sessions of concurrent practice of the cognitive and postural tasks. After training, performance of a concurrent cognitive task increased postural sway in the no-training and single-task training groups but not in the dual-task training group. Results suggest that dual-task practice improves dual-task performance.     

Power spectral density analysis of the standing sway of males

Application of power spectral density analysis to normal human standing sway showed that the power in sway was unevenly distributed among various frequencies below 1.0 Hz. Ss were divided, with regard to antero-posterior sway, into two types on the basis of the frequencies at which peaks of power occurred. The same Ss were divided into four types, with regard to lateral sway, using similar criteria. The different types appear to represent normal variations in the basic mechanism for standing upright.     

Anticipatory control of postural and task muscles during rapid arm flexion

A multicomponent pattern of premovement (anticipatory) activity in both task and postural muscles was examined for a unilateral rapid arm flexion movement (Belen'kii, Gurflnkel, & Pal'tsev, 1967) performed under simple visual reaction-time conditions. Subjects performed 30 right- and 30 left-side responses on each of four consecutive days. The anticipatory postural muscle activity may be considered a valid component of voluntary unilateral arm flexion. Invariances and variability in the spatial and temporal characteristics of the neuromuscular pattern are described in relationship to behavioral and motor control models of response organization. It is suggested that some temporal patterning among response components may not be preprogrammed centrally.     

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.     

The role of central and peripheral vision in postural control during walking

Three hypotheses have been proposed for the roles of central and peripheral vision in the perception and control of self-motion: (1) peripheral dominance, (2) retinal invariance, and (3) differential sensitivity to radial flow. We investigated postural responses to optic flow patterns presented at different retinal eccentricities during walking in two experiments. Oscillating displays of radial flow (0 degree driver direction), lamellar flow (90 degrees), and intermediate flow (30 degrees, 45 degrees) patterns were presented at retinal eccentricities of 0 degree, 30 degrees, 45 degrees, 60 degrees, or 90 degrees to participants walking on a treadmill, while compensatory body sway was measured. In general, postural responses were directionally specific, of comparable amplitude, and strongly coupled to the display for all flow patterns at all retinal eccentricities. One intermediate flow pattern (45 degrees) yielded a bias in sway direction that was consistent with triangulation errors in locating the focus of expansion from visible flow vectors. The results demonstrate functionally specific postural responses of both central and peripheral vision, contrary to the peripheral dominance and differential sensitivity hypotheses, but consistent with retinal invariance. This finding emphasizes the importance of optic flow structure for postural control regardless of the retinal locus of stimulation.     

Respiration and postural sway: detection of phase synchronizations and interactions

The aim of the central nervous system in upright stance is to control an intrinsically unstable plant. Internal disturbances, such as haemodynamics and respiration, constitute an endogenous threat to equilibrium. The way CNS reacts to those perturbations was studied in this work, through the analysis of summary scores taken from posturographic and pneumographic data. Signals were recorded simultaneously during trials administered on a sample population of healthy young adults, while sitting and standing and at paced and spontaneous uncontrolled breathing. The extraction of posturographic and pneumographic parameters was accompanied by the utilization of techniques for the detection of phase synchronization in bivariate data, and the extraction of an interaction index, the mutual information MI. The effects of the biomechanical condition and respiratory amplitude on MI and summary measures were tested with a two-way ANOVA. Summary scores clearly depend on posture condition. Synchronization between breath and postural sway is always present, depends on both biomechanical condition and respiratory threat, and cannot be reduced to a simple linear relation.     

Effects of visual environment on quiet standing by young and old adults

The authors manipulated the circumstances in which individuals are typically embedded when standing upright by manipulating the intensity of light and the stationary structure of the environment. They expected that the manipulations would affect 12 older participants (aged 65-82 years) more than it would 12 younger participants (aged 22-24 years). Linear (e.g., total path length) and nonlinear (e.g., maximum line length of recurrent points in phase space) measures of the center of pressure time series confirmed that expectation. Moreover, for some measures, there was a suggestion that participants' visual contrast sensitivity (an index of neurophysiological age) was a more important contributing factor overall than was their chronological age. In the Discussion, the authors highlight the significance of interactive effects of environmental, organismic, and task constraints on quiet standing.