Identification and Organization of a Postural Anti-Gravity Module in the Cerebellar Vermis

The cerebellum is known to control the proper balance of isometric muscular contractions that maintain body posture. Current optogenetic manipulations of the cerebellar cortex output, however, have focused on ballistic body movements, examining movement initiation or perturbations. Here, by optogenetic stimulations of cerebellar Purkinje cells, which are the output of the cerebellar cortex, we evaluate body posture maintenance. By sequential analysis of body movement, we dissect the effect of optogenetic stimulation into a directly induced movement that is then followed by a compensatory reflex to regain body posture. We identify a module in the medial part of the anterior vermis which, through multiple muscle tone regulation, is involved in postural anti-gravity maintenance of the body. Moreover, we report an antero-posterior and medio-lateral functional segregation over the vermal lobules IV/V/VI. Taken together our results open new avenues for better understanding of the modular functional organization of the cerebellar cortex and its role in postural anti-gravity maintenance.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis

Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.

The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis

PURPOSE OF REVIEW

This review aims to explore which cognitive domain is more closely associated with which type of balance (static or dynamic).

RESENT FINDING

Based on recent reviews, inhibitory control, a part of cognition, plays a crucial role in balance performance. Previous reviews report significant links between cognition, mobility, and physical function in older adults. However, evidence regarding the relationship between cognition and balance scores remains inconclusive. The strength of association between cognition and balance appears to be domain-specific and task-specific. Executive function exhibits the strongest correlation with balance, while episodic memory shows a small link with dynamic balance. Processing speed and global cognition demonstrate moderate correlations. Additionally, there is a slight association between cognitive domains and static balance. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for managing balance-related concerns that are domain-specific and task-specific.

History-dependent muscle resistance to stretch remains high after small, posturally relevant pre-movements

The contributions of intrinsic muscle fiber resistance during mechanical perturbations to standing and other postural behaviors are unclear. Muscle short-range stiffness is known to vary depending on the current level and history of the muscle's activation, as well as the muscle's recent movement history; this property has been referred to as history dependence or muscle thixotropy. However, we currently lack sufficient data about the degree to which muscle stiffness is modulated across posturally relevant characteristics of muscle stretch and activation. We characterized the history dependence of muscle's resistance to stretch in single, permeabilized, activated, muscle fibers in posturally relevant stretch conditions and activation levels. We used a classic paired muscle stretch paradigm, varying the amplitude of a 'conditioning' triangular stretch-shorten cycle followed by a 'test' ramp-and-hold imposed after a variable inter-stretch interval. We tested low (<15%), intermediate (15-50%) and high (>50%) muscle fiber activation levels, evaluating short-range stiffness and total impulse in the test stretch. Muscle fiber resistance to stretch remained high at conditioning amplitudes of <1% optimal fiber length, L0, and inter-stretch intervals of >1 s, characteristic of healthy standing postural sway. An ∼70% attenuation of muscle resistance to stretch was reached at conditioning amplitudes of >3% L0 and inter-stretch intervals of <0.1 s, characteristic of larger, faster postural sway in balance-impaired individuals. The thixotropic changes cannot be predicted solely on muscle force at the time of stretch. Consistent with the disruption of muscle cross-bridges, muscle resistance to stretch during behavior can be substantially attenuated if the prior motion is large enough and/or frequent enough.

Distinct cortical correlates of perception and motor function in balance control

Fluctuations in brain state alter how we perceive our body and generate movements but have not been investigated in functional whole-body behaviors. During reactive balance control, we recently showed that evoked brain activity is associated with balance ability in healthy young individuals. Further, in individuals with Parkinson's disease, impairments in whole-body motion perception in reactive balance are associated with clinical balance impairment. Here we investigated brain activity during whole-body motion perception in reactive balance in healthy young adults. We hypothesized that flexibility in brain states underlies successful perception and movement during whole-body movement. We characterized two cortical sensorimotor signals using electroencephalography localized to the supplementary motor area: 1) the "N1 response", a perturbation-evoked potential that decreases in amplitude with expectancy and is larger in individuals with lower balance function; and 2) pre-perturbation beta oscillatory activity, a rhythm that favors maintenance of the current sensorimotor state and is inversely associated with perception in seated somatosensory perceptual tasks. In a two-alternative forced choice task, participants judged whether pairs of backward support-surface perturbations during standing were in the "same" or "different" direction. As expected, lower whole-body perception was associated with lower balance ability. Within a perturbation pair, N1 attenuation was larger on correctly perceived trials and associated with better balance, but not perception. In contrast, pre-perturbation beta power was higher on incorrectly perceived trials and associated with poorer perception, but not balance. Taken together, flexibility in different cortical processes influences perceptual accuracy but have distinct associations with balance and perceptual ability.

Sensorimotor recalibration of postural control strategies occurs after whole body vibration

Efficient postural control results from an effective interplay between sensory feedbacks integration and muscle modulation and can be affected by ageing and neuromuscular injuries. With this study, we investigated the effect of whole-body vibratory stimulation on postural control strategies employed to maintain an upright posture. We explored both physiological and posturography metrics, through corticomuscular and intramuscular coherence, and muscle networks analyses. The stimulation disrupts balance in the short term, but leads to a greater contribution of cortical activity, necessary to modulate muscle activation via the formation of (new) synergies. We also observed a reconfiguration of muscle recruitment patterns that returned to pre-stimulation levels after few minutes, accompanied by a slight improvement of balance in the anterior-posterior direction. Our results suggest that, in the context of postural control, appropriate mechanical stimulation is capable of triggering a recalibration of the sensorimotor set and might offer new perspectives for motor re-education.

USING THE SENSORY INTEGRATION TECHNIQUE FOR PEOPLE WITH AUTISM SPECTRUM DISORDERS DURING TRAINING AT THE CLIMBING SECTION

OBJECTIVE

Aim: To analyze the practical application of the sensory integration technique for individuals with autism spectrum disorder at a climbing section, and to investigate the impact of physical activity on improving their proprioceptive and vestibular systems.

PATIENTS AND METHODS

Materials and Methods: The method of included participant observation at the climbing classes with constant recording the behavior (desirable and undesirable) was used. The sensory screening (developed by J. Ayres) was applied for recording and determining the sensory systems of the people with ASD before the start of training and again after a month. The scale of Sensory Integration and Praxis Tests (SIPT) was used for assessing certain aspects of participants' sensory processing or perception according to the goals set during the climbing classes.

RESULTS

Results: The results of the research showed that the application of the sensory integration technique for individuals with ACD at a climbing section promoted the dynamics of changes in their sensory system during training considering the characteristics of their sensory system. The positive changes were observed in the way the people with ACD felt about their own bodies and their involvement in sports activities that in its turn made it possible to be active and develop their sensory system. It has been identified that while planning training for the people with ASD it is necessary to take into account sensory modulation (reading sensory signals) and apply exercises for stimulating sensory sensations that will improve the motor activity of persons with ASD, their social interaction, and safety, as well.

CONCLUSION

Conclusions: During training at the climbing section sensory information processing of the individuals with ASD have the impact on their body control, hand-eye coordination, and hand sensitivity during training. The improvement of sensory information processing in its turn enables people with ASD to master climbing.

The human motor cortex contributes to gravity compensation to maintain posture and during reaching

The neural control of posture and movement is interdependent. During voluntary movement, the neural motor command is executed by the motor cortex through the corticospinal tract and its collaterals and subcortical targets. Here we address the question of whether the control mechanism for the postural adjustments at nonmoving joints is also involved in overcoming gravity at the moving joints. We used single-pulse transcranial magnetic stimulation to measure the corticospinal excitability in humans during postural and reaching tasks. We hypothesized that the corticospinal excitability is proportional to background muscle activity and the gravity-related joint moments during both static postures and reaching movements. To test this hypothesis, we used visual targets in virtual reality to instruct five postures and three movements with or against gravity. We then measured the amplitude and gain of motor evoked potentials in multiple arm and hand muscles at several phases of the reaching motion and during static postures. The stimulation caused motor evoked potentials in all muscles that were proportional to the muscle activity. During both static postures and reaching movements, the muscle activity and the corticospinal contribution to these muscles changed in proportion with the postural moments needed to support the arm against gravity, supporting the hypothesis. Notably, these changes happened not only in antigravity muscles. Altogether, these results provide evidence that the changes in corticospinal excitability cause muscle cocontraction that modulates limb stiffness. This suggests that the motor cortex is involved in producing postural adjustments that support the arm against gravity during posture maintenance and reaching.NEW & NOTEWORTHY Animal studies suggest that the corticospinal tract and its collaterals are crucial for producing postural adjustments that accompany movement in limbs other than the moving limb. Here we provide evidence for a similar control schema for both arm posture maintenance and gravity compensation during movement of the same limb. The observed interplay between the postural and movement control signals within the corticospinal tract may help explain the underlying neural motor deficits after stroke.

Changes in operation of postural networks in rabbits with postural functions recovered after lateral hemisection of the spinal cord

Acute lateral hemisection of the spinal cord (LHS) severely impairs postural functions, which recover over time. Here, to reveal changes in the operation of postural networks underlying the recovery, male rabbits with recovered postural functions after LHS at T12 (R-rabbits) were used. After decerebration, we characterized the responses of individual spinal interneurons from L5 along with hindlimb EMG responses to stimulation causing postural limb reflexes (PLRs) that substantially contribute to postural corrections in intact animals. The data were compared with those obtained in our previous studies of rabbits with the intact spinal cord and rabbits after acute LHS. Although, in R-rabbits, the EMG responses to postural disturbances both ipsilateral and contralateral to the LHS (ipsi-LHS and co-LHS) were only slightly distorted, PLRs on the co-LHS side (unaffected by acute LHS) were distorted substantially and PLRs on the ipsi-LHS side (abolished by acute LHS) were close to control. Thus, in R-rabbits, plastic changes develop in postural networks both affected and unaffected by acute LHS. PLRs on the ipsi-LHS side recover mainly as a result of changes at brainstem-cerebellum-spinal levels, whereas the forebrain is substantially involved in the generation of PLRs on the co-LHS side. We found that, in areas of grey matter in which the activity of spinal neurons of the postural network was significantly decreased after acute LHS, it recovered to the control level, whereas, in areas unaffected by acute LHS, it was significantly changed. These changes underlie the recovery and distortion of PLRs on the ipsi-LHS and co-LHS sides, respectively. KEY POINTS: After lateral hemisection of the spinal cord (LHS), postural functions recover over time. The underlying changes in the operation of postural networks are unknown. We compared the responses of individual spinal neurons and hindlimb muscles to stimulation causing postural limb reflexes (PLRs) in recovered LHS-rabbits with those obtained in rabbits with the intact spinal cord and rabbits after acute LHS. We demonstrated that changes underlying the recovery of postural functions take place not only in postural networks that are severely impaired, but also in those that are almost unaffected by acute LHS. PLRs on the LHS side recover mainly as a result of changes at brainstem-cerebellum-spinal levels, whereas the forebrain is substantially involved in the generation of PLRs contralateral to the LHS.

Effect of individualized cognitive and postural task difficulty levels on postural control during dual task condition

BACKGROUND

Previous dual task studies suggested that the difficulty of the concurrent cognitive and motor tasks may not be challenging to the same degree for each person. This study approaches this problem by setting individualized difficulty levels for tasks to examine the dual task interference.

RESEARCH QUESTION

Do the features of postural sway depend on increased individualized difficulty levels of concurrent cognitive and postural activities?

METHODS

20 young healthy participants (10 male, 10 female) took part in the study. Before the experiments, cognitive task difficulty (No-, Medium-, High) has been set individually. Subjects performed postural tasks (quiet stance, voluntary sway) concurrently with or without a cognitive task which based on simple arithmetic calculations. Postural sway features were examined.

RESULTS

Postural sway features were affected by individualized difficulty level of concurrent cognitive and postural activities. In voluntary sway, as a more challenging postural task, higher reductions were observed for such sway features as COP velocity and range in AP direction.

SIGNIFICANCE

This study signaled task-specific changes in postural sway features. When the difficulty levels were set individually, the effect of motor and cognitive dual task was more apparent when the balance requirement of the primary motor task increased.

The effect of limited sensory information on exoskeleton performance in people with complete spinal cord injury

Despite the absence of somatosensory information from the lower extremities, people with complete spinal cord injury (SCI) can maintain postural stability in an exoskeleton. This is partly because humans are able to reweigh the relative dependence on each of the senses. However, when the sensory environment is changed, people with complete SCI are limited in their ability to reweigh their sensory organization towards more dependence on somatosensory information. The aim of this study was to investigate the effect of limited visual and/or auditory information on exoskeleton performance in people with complete SCI. Three experienced exoskeleton users performed twelve walking trials in the ReWalk exoskeleton. In each trial, the presence or absence of visual and/or auditory information was varied. Exoskeleton performance was operationalized as the walking distance covered and the amount of crutch loading. In one participant, the distance covered decreased when visual information was limited. The other two participants did not show substantial differences in distance covered between sensory conditions. Two participants decreased crutch loading when visual information was restricted, and one participant decreased crutch loading when auditory information was limited. The current study suggests a limited influence of the presence or absence of visual and auditory information on the distance covered in people with complete SCI walking in an exoskeleton. Interestingly, crutch loading seemed to decrease rather than increase when visual or auditory information was limited.

Beam width and arm position but not cognitive task affect walking balance in older adults

Detection of changes in dynamic balance could help identify older adults at fall risk. Walking on a narrow beam with its width, cognitive load, and arm position manipulated could be an alternative to current tests. Therefore, we examined additive and interactive effects of beam width, cognitive task (CT), and arm position on dynamic balance during beam walking in older adults. Twenty older adults (69 ± 4y) walked on 6, 8, and 10-cm wide beams (2-cm high, 4-m-long), with and without CT, with three arm positions (free, crossed, akimbo). We determined cognitive errors, distance walked, step speed, root mean square (RMS) of center of mass (COM) displacement and trunk acceleration in the frontal plane. Beam width decrease progressively reduced distance walked and increased trunk acceleration RMS. Step speed decreased on the narrowest beam and with CT. Arm crossing decreased distance walked and step speed. COM displacement RMS and cognitive errors were not affected by any manipulation. In conclusion, distance walked indicated that beam width and arm position, but less so CT, affected dynamic balance, implying that beam walking has the potential to become a test of fall risk. Stability measurements suggested effective trunk adjustments to control COM position and keep dynamic balance during the task.

Assessment of Biomechanical Predictors of Occurrence of Low-Amplitude N1 Potentials Evoked by Naturally Occurring Postural Instabilities

Naturally occurring postural instabilities that occur while standing and walking elicit specific cortical responses in the fronto-central regions (N1 potentials) followed by corrective balance responses to prevent falling. However, no framework could simultaneously track different biomechanical parameters preceding N1s, predict N1s, and assess their predictive power. Here, we propose a framework and show its utility by examining cortical activity (through electroencephalography [EEG]), ground reaction forces, and head acceleration in the anterior-posterior (AP) direction. Ten healthy young adults carried out a balance task of standing on a support surface with or without sway referencing in the AP direction, amplifying, or dampening natural body sway. Using independent components from the fronto-central cortical region obtained from subject-specific head models, we first robustly validated a prior approach on identifying low-amplitude N1 potentials before early signs of balance corrections. Then, a machine learning algorithm was used to evaluate different biomechanical parameters obtained before N1 potentials, to predict the occurrence of N1s. When different biomechanical parameters were directly compared, the time to boundary (TTB) was found to be the best predictor of the occurrence of upcoming low-amplitude N1 potentials during a balance task. Based on these findings, we confirm that the spatio-temporal characteristics of the center of pressure (COP) might serve as an essential parameter that can facilitate the early detection of postural instability in a balance task. Extending our framework to identify such biomarkers in dynamic situations like walking might improve the implementation of corrective balance responses through brain-machine-interfaces to reduce falls in the elderly.

A Review of the Potential of Virtual Walking Techniques for Gait Rehabilitation

Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait disturbances in different cohorts of patients (such as Parkinson's disease, post-stroke, or other neurological disorders) as it allows patients to be engaged in an immersive and artificial environment, which can be designed to address the particular needs of each individual. This review demonstrates the state of the art in applications of virtual walking techniques and related technologies for gait therapy and rehabilitation of people with movement disorders makes recommendations for future research and discusses the use of VR in the clinic. However, the potential for using these techniques in gait rehabilitation is to provide a more personalized approach by simulate the experience of natural walking, while patients with neurological disorders are maintained localized in the real world. The goal of our work is to investigate how the human nervous system controls movement in health and neurodegenerative disease.

Postural control in the elephant

As the largest extant legged animals, elephants arguably face the most extreme challenge for stable standing. In this study, we investigated the displacement of the centre of pressure of 12 elephants during quiet standing. We found that the average amplitude of the oscillations in the lateral and fore-aft directions was less than 1.5 cm. Such amplitudes for postural oscillation are comparable with those of dogs and other species, suggesting that some aspects of sensorimotor postural control do not scale with size.

Effect of spinal cord injury on neural encoding of spontaneous postural perturbations in the hindlimb sensorimotor cortex

Supraspinal signals play a significant role in compensatory responses to postural perturbations. Although the cortex is not necessary for basic postural tasks in intact animals, its role in responding to unexpected postural perturbations after spinal cord injury (SCI) has not been studied. To better understand how SCI impacts cortical encoding of postural perturbations, the activity of single neurons in the hindlimb sensorimotor cortex (HLSMC) was recorded in the rat during unexpected tilts before and after a complete midthoracic spinal transection. In a subset of animals, limb ground reaction forces were also collected. HLSMC activity was strongly modulated in response to different tilt profiles. As the velocity of the tilt increased, more information was conveyed by the HLSMC neurons about the perturbation due to increases in both the number of recruited neurons and the magnitude of their responses. SCI led to attenuated and delayed hindlimb ground reaction forces. However, HLSMC neurons remained responsive to tilts after injury but with increased latencies and decreased tuning to slower tilts. Information conveyed by cortical neurons about the tilts was therefore reduced after SCI, requiring more cells to convey the same amount of information as before the transection. Given that reorganization of the hindlimb sensorimotor cortex in response to therapy after complete midthoracic SCI is necessary for behavioral recovery, this sustained encoding of information after SCI could be a substrate for the reorganization that uses sensory information from above the lesion to control trunk muscles that permit weight-supported stepping and postural control.NEW & NOTEWORTHY The role of cortical circuits in the encoding of posture and balance is of interest for developing therapies for spinal cord injury. This work demonstrated that unexpected postural perturbations are encoded in the hindlimb sensorimotor cortex even in the absence of hindlimb sensory feedback. In fact, the hindlimb sensorimotor cortex continues to encode for postural perturbations after complete spinal transection.

Evaluation of movement and brain activity

Clinical neurophysiology studies can contribute important information about the physiology of human movement and the pathophysiology and diagnosis of different movement disorders. Some techniques can be accomplished in a routine clinical neurophysiology laboratory and others require some special equipment. This review, initiating a series of articles on this topic, focuses on the methods and techniques. The methods reviewed include EMG, EEG, MEG, evoked potentials, coherence, accelerometry, posturography (balance), gait, and sleep studies. Functional MRI (fMRI) is also reviewed as a physiological method that can be used independently or together with other methods. A few applications to patients with movement disorders are discussed as examples, but the detailed applications will be the subject of other articles.

The Effects of Internal Attention on Knee Biomechanics in Volleyball Spike Jump through Augmented Video Feedback

Poor knee biomechanics in a volleyball spike jump generally result in a higher knee injury risk, which can be altered by an internal focus of attention (FOA). The constrained action hypothesis (CAH) purports that the FOA inhibits sports performance whereas no ecologically valid evidence has been found in previous studies. The purpose of this research is to explore the effect of video feedback on knee biomechanics in a volleyball spike jump including landing and take-off phases. The video feedback was performed in a natural way. Fourteen volleyball male players were recruited in this study. A paired t-test was used to detect the effect of the feedback; meanwhile, statistical parameter mapping (SPM) statistics were used for the continuum differences during movement. After biofeedback, the initial contact flexion angle of the knee (t = 2.179, p = 0.049), the maximal flexion angle of the knee (t = 3.242, p = 0.006) and the maximal internal rotation angular velocity of the knee (t = 5.209, p = 0.003) increased significantly; the maximal extension moment of the knee (t = 3.962, p < 0.001) and the maximal flexion moment of the knee (t = −3.711, p = 0.002) significantly decreased; the maximal abduction moment significantly decreased (t = 3.069, p = 0.037) but the maximal internal rotation moment significantly increased (t = 2.813, p = 0.018); the first peak of the vertical ground reaction force (vGRF) (t = 7.618, p < 0.001) and the average loading rate to the first peak (t = 4.205, p = 0.004) significantly decreased; the other peaks of the vGRF were not found to have differences; a larger knee flexion was found during the phase from 31.17 to 73.19% (t = 2.611, p = 0.012); a larger adduction angular velocity was found during the phase from 49.07 to 62.46% (t = 3.148, p = 0.004); a smaller external rotational angular velocity was found during the phase from 45.85 to 49.96% (t = 5.011 p = 0.017); there was an increased flexion moment of the knee during the phase from 19.72 to 21.38% (t = 0.029, p = 0.029) and an external moment of the knee during the phase from 85.55 to 95.06% (t = 4.214, p < 0.001); the vGRF significantly decreased during the phase from 3.13 to 5.94% (t = 4.096, p = 0.014) and 19.83–21.97% (t = 4.096, p = 0.024) but significantly increased in the phase of 91.43–100% (t = 4.096, p < 0.001). The impulse of the vGRF and knee power were not found to be different compared with before biofeedback. Therefore, our study suggests video feedback in a natural practice has the potential to improve knee movement whilst not altering the performance in a volleyball spike jump. This indicates that the CAH theory is possibly not suitable in a real competition. Due to the complexity of human movements and the limitations of this study, muscle activities must be considered in the future.

Identifying human postural dynamics and control from unperturbed balance

Background

Upright standing requires control of an inherently unstable multi-joint human body within a small base of support, despite biological motor and / or sensory noise which challenge balance. Without applying perturbations, system identification methods have been regarded as inadequate, because the relevant internal biological noise processes are not accessible to direct measurement. As a result, unperturbed balance studies have been limited to investigation of behavioral patterns rather than possible underlying control strategies.

Methods

In this paper, we present a mathemathically rigorous system identification method that is applicable to study the dynamics and control of unperturbed balance. The method is derived from autocorrelation matrices with non-zero time lags and identifies the system matrix of a discrete-time dynamic system in the presence of unknown noise processes, without requiring any information about the strength of the noise.

Results

Unlike reasonable ‘least-squares’ approaches, the performance of the new method is consistent across a range of different combinations of internal and measurement noise strengths, even when measurement noise is substantial. We present a numerical example of a model that simulates human upright balancing and show that its dynamics can be identified accurately. With a biomechanically reasonable choice of state and input variables, a state feedback controller can also be identified.

Conclusions

This study provides a new method to correctly identify the dynamics of human standing without the need for known external perturbations. The method was numerically validated using simulation that included realistic features of human balance. This method avoids potential issues of adaptation or possible reflex responses evoked by external perturbations, and does not require expensive in-lab, high-precision measurement equipment. It may eventually enable diagnosis and treatment of individuals with impaired balance, and the development of safe and effective assistive and / or rehabilitative technologies.

Balance, Lateropulsion, and Gait Disorders in Subacute Stroke

OBJECTIVE

To test the hypothesis that impaired body orientation with respect to gravity (lateropulsion) would play a key role in poststroke balance and gait disorders.

METHODS

Cohort study of 220 individuals consecutively admitted to a neurorehabilitation ward after a first hemisphere stroke (DOBRAS cohort [Determinants of Balance Recovery After Stroke] 2012-2018, ClinicalTrials.gov: NCT03203109), with clinical data systematically collected at 1 month, then at discharge. Primary outcomes were balance and gait disorders, quantified by the Postural Assessment Scale for Stroke and the modified Fugl-Meyer Gait Assessment, to be explained by all deficits on day 30, including lateropulsion assessed with the Scale for Contraversive Pushing. Statistics comprised linear regression analysis, univariate and multivariate analyses, and receiver operating characteristic curves.

RESULTS

Lateropulsion was frequent, especially after right hemisphere stroke (RHS, D30, 48%; discharge 24%), almost always in right-handers. Among all deficits, impaired body orientation (lateropulsion) had the most detrimental effect on balance and gait. After RHS, balance disorders were proportional to lateropulsion severity, which alone explained almost all balance disorders at initial assessment (90%; 95% confidence interval [CI] [86-94], p < 0.001) and at discharge (92%; 95% CI 89-95, p < 0.001) and also the greatest part of gait disorders at initial assessment (66%; 95% CI 56-77, p < 0.001) and at discharge (68%; 95% CI 57-78, p < 0.001).

CONCLUSION

Lateropulsion is the primary factor altering poststroke balance and gait at the subacute stage and therefore should be systematically assessed. Poststroke balance and gait rehabilitation should incorporate techniques devoted to misorientation with respect to gravity.

Reliability and Validity of Turkish Version of The Brief-BESTest in Stroke Patients

BACKGROUND

The Brief-BESTest is the short version of the BESTest used to evaluate balance and fall risk in a multiple disease populations. The clinicians need practical, short application scales to evaluate the risk of falling, balance and rehabilitation results.

OBJECTIVE

This study aims to investigate the validity and reliability of the Turkish version of the Brief-BESTest (Brief-BESTest-T) in stroke patients.

METHODS

This study included a total of 40 subacute and chronic stroke patients (mean age of 60.28 ± 9.96 years). The Brief-BESTest, Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Falls Efficacy Scale (FES) and 10 m walking test were applied to the patients.

RESULTS

A strong correlation was observed between the1st and 2nd evaluation Brief-BESTest-T total scores (r = 0.933). Cronbach's alpha coefficient was excellent. According to the correlation analysis performed to test the inter-rater reliability, a very high correlation (r = 0.906) was observed between the Brief-BESTest-T total scores. A high correlation was found between the Brief-BESTest-T and BBS and TUG, while a moderate correlation was found between the FRT, FES, and 10 m walking test. The clinical cut-off point for the Brief-BESTest - T was determined to be 9 points with an AUC of 0.872. There were no floor and ceiling effects found.

CONCLUSIONS

This study showed that the Brief-BESTest-T had excellent internal consistency, intra-rater, and inter-rater reliability. Its concurrent, discriminant, and known-groups validity were also good and had no substantial floor and ceiling effects.

Patterns of muscle activation and modulation of ankle intrinsic stiffness in different postural operating conditions

Intrinsic stiffness describes the dynamic relationship between imposed angular perturbations to a joint and the resulting torque response, due to intrinsic mechanical properties of muscles and joint, and inertia of the limbs. Recently, we showed that ankle intrinsic stiffness changes substantially with sway in normal standing. In the present study, we documented how ankle intrinsic stiffness changes with postural operating conditions. Subjects stood on an apparatus while subjected to ankle position perturbations in five conditions: normal standing, toe-up and toe-down standing, and backward and forward lean. In each condition, ankle intrinsic stiffness was estimated while its modulation with sway was accounted for. The results demonstrated that ankle intrinsic stiffness varies widely, from 0.08 to 0.75 of critical stiffness, across postural operating conditions; however, it is always smaller than the critical stiffness. Therefore, other contributions are necessary to ensure stable standing. The mean intrinsic stiffness was highest in forward lean and lowest in backward lean. Moreover, within each operating condition, the intrinsic stiffness changed with center-of-pressure position in one of three ways, each associated with a distinct muscle activation pattern; these include 1) monotonically increasing stiffness-center of pressure relation, associated with a progressive increase in triceps surae activation, 2) decreasing-increasing stiffness-center of pressure relation, associated with initial activation of tibialis anterior and later activation of triceps surae, and 3) monotonically decreasing stiffness-center of pressure relation, associated with decreasing activation of tibialis anterior. Thus intrinsic stiffness varies greatly within and across postural operating conditions, and a correct understanding of postural control requires accounting for such variations.NEW & NOTEWORTHY Ankle intrinsic stiffness changes with sway in normal standing. We quantified such changes in different postural operating conditions and demonstrated that the intrinsic stiffness changes in a manner associated with different activation patterns of ankle plantarflexors and dorsiflexors, emerging in different operating conditions. Large modulations of the intrinsic stiffness within and across postural operating conditions show that the stiffness importance and contribution change and must be accounted for in the study of postural control.

Adaptation to Coriolis force perturbations of postural sway requires an asymmetric two-leg model

In the companion paper (Bakshi A, DiZio P, Lackner JR. J Neurophysiol. In press, 2019), we reported how voluntary forward-backward sway in a rotating room generated medial-lateral Coriolis forces that initially deviated intended body sway paths. Pure fore-aft sway was gradually restored over per-rotation trials, and a negative aftereffect occurred during postrotation sway. Force plate recordings showed that subjects learned to compensate for the Coriolis forces by executing a bimodal torque, the distribution of which was asymmetric across the two legs and of opposite sign for forward vs. backward sway. To explain these results, we have developed an asymmetric, nonparallel-leg, inverted pendulum model to characterize upright balance control in two dimensions. Fore-aft and medial-lateral sway amplitudes can be biomechanically coupled or independent. Biomechanical coupling occurs when Coriolis forces orthogonal to the direction of movement perturb sway about the ankles. The model includes a mechanism for alternating engagement/disengagement of each leg and for asymmetric drive to the ankles to achieve adaptation to Coriolis force-induced two-dimensional sway. The model predicts the adaptive control underlying the adaptation of voluntary postural sway to Coriolis forces. A stability analysis of the model generates parameter values that match those measured experimentally, and the parameterized model simulations reproduce the experimentally observed sway trajectories. NEW & NOTEWORTHY This paper presents a novel nonparallel leg model of postural control that correctly predicts the perturbations of voluntary sway that occur in a rotating environment and the adaptive changes that occur to restore faithful movement trajectories. This engaged leg model (ELM) predicts the asymmetries in force distribution and their patterns between the two legs to restore accurate movement trajectories. ELM has clinical relevance for pathologies that generate postural asymmetries and for altered gravitoinertial force conditions.

Postural control of a musculoskeletal model against multidirectional support surface translations

The human body is a complex system driven by hundreds of muscles, and its control mechanisms are not sufficiently understood. To understand the mechanisms of human postural control, neural controller models have been proposed by different research groups, including our feed-forward and feedback control model. However, these models have been evaluated under forward and backward perturbations, at most. Because a human body experiences perturbations from many different directions in daily life, neural controller models should be evaluated in response to multidirectional perturbations, including in the forward/backward, lateral, and diagonal directions. The objective of this study was to investigate the validity of an NC model with FF and FB control under multidirectional perturbations. We developed a musculoskeletal model with 70 muscles and 15 degrees of freedom of joints, positioned it in a standing posture by using the neural controller model, and translated its support surface in multiple directions as perturbations. We successfully determined the parameters of the neural controller model required to maintain the stance of the musculoskeletal model for each perturbation direction. The trends in muscle response magnitudes and the magnitude of passive ankle stiffness were consistent with the results of experimental studies. We conclude that the neural controller model can adapt to multidirectional perturbations by generating suitable muscle activations. We anticipate that the neural controller model could be applied to the study of the control mechanisms of patients with torso tilt and diagnosis of the change in control mechanisms from patients' behaviors.

Does postural stability differ between adolescents with idiopathic scoliosis and typically developed? A systematic literature review and meta-analysis

BACKGROUND

Postural stability deficits have been proposed to influence the onset and progression of adolescent idiopathic scoliosis (AIS). This study aimed to systematically identify, critically evaluate and meta-analyse studies assessing postural stability during unperturbed stance with posturography in AIS compared to typically developed adolescents.

METHODS

Studies from four electronic databases (PubMed, Scopus, CINAHL, PEDro) were searched and case-control methodological quality assessed using a risk-of-bias assessment tool and a posturography methodological quality checklist. Pooled data regarding centre of pressure (COP) parameters such as sway area, Mediolateral (ML) and Anteroposterior (AP) position and range were compared for AIS and typically developed adolescents using Cohen's d effect size (ES) and homogeneity estimates.

RESULTS

Eighteen studies for quality analysis and 9 of these for meta-analysis were identified from 971 records. Risk-of-bias assessment identified 6 high, 10 moderate and 2 low risk-of-bias studies. The posturography methodological quality checklist identified 4 low, 7 moderate and 7 high-quality studies. Meta-analysis was performed for sway area whereas ML and AP are presented in three different meta-analyses due to divergent measurement units used in the studies: ML position 1 (MLP1), ML position 2 (MLP2) and ML range (MLR); AP position 1 (APP1), AP position 2 (APP2) and AP range (APR). Cohen's d showed a medium ES difference in sway area 0.65, 95% CI (0.49-0.63), whereas ML showed no (MLP1, MLP2) and large (MLR) ES differences; MLP1 0.15, 95% CI (0.08-0.22); MLP2 0.14, 95% CI (0.08-0.19); and MLR 0.94, 95% CI (0.83-1.04). Cohen's d for AP showed small ES (APP1) and large ES difference (APP2 and APR); APP1 0.43, 95% CI (0.31-0.54); APP2 0.85, 95% CI (0.72-0.97); and APR 0.98, 95% CI (0.87-1.09). Cochran's Q and Higgins I2 showed homogeneity between studies.

CONCLUSIONS

There is moderate quality evidence for decreased postural stability in AIS measured as COP parameters sway area, ML and AP range with a positional shift posteriorly in the sagittal plane. The findings support studying postural stability in early stage AIS and also prospectively identify cause and effect of the curvature as well as effectiveness of postural control interventions in the prevention of scoliosis progression.

A systematic review of the effectiveness of task-specific rehabilitation interventions for improving independent sitting and standing function in spinal cord injury

CONTEXT

Impaired balance function after a spinal cord injury (SCI) hinders performance of daily activities.

OBJECTIVE

To assess the evidence on the effectiveness of task-specific training on sitting and standing function in individuals with SCI across the continuum of care.

METHODS

A systematic search was conducted on literature published to June 2016 using people (acute or chronic SCI), task-specific interventions compared to conventional physical therapy, and outcome (sitting or standing balance function). The PEDro scale was used to investigate the susceptibility to bias and trial quality of the randomized controlled trials (RCTs). A standardized mean difference (SMD) was conducted to investigate the effect size for interventions with sitting or standing balance outcomes.

RESULTS

Nineteen articles were identified; three RCTs, two prospective controlled trials, one cross-over study, nine pre-post studies and four prospective cohort studies. RCT and cross-over studies were rated from 6 to 8 indicating good quality on the PEDro scale. The SMD of task-specific interventions in sitting compared to active and inactive (no training) control groups was -0.09 (95% CI: -0.663 to 0.488) and 0.39 (95% CI: -0.165 to 0.937) respectively, indicating that the addition of task-specific exercises did not affect sit and reach test performance significantly. Similarly, the addition of BWS training did not significantly affect BBS compared to conventional physical therapy -0.36 (95% CI: -0.840 to 0.113). Task-specific interventions reported in uncontrolled trials revealed positive effects on sitting and standing balance function.

CONCLUSION

Few RCT studies provided balance outcomes, and those that were evaluated indicate negligible effect sizes. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further research to evaluate specific features of training interventions to improve both sitting and standing balance function in SCI.

The Contribution of Upper Body Movements to Dynamic Balance Regulation during Challenged Locomotion

Recent studies suggest that in addition to movements between ankle and hip joints, movements of the upper body, in particular of the arms, also significantly contribute to postural control. In line with these suggestions, we analyzed regulatory movements of upper and lower body joints supporting dynamic balance regulation during challenged locomotion. The participants walked over three beams of varying width and under three different verbally conveyed restrictions of arm posture, to control the potential influence of arm movements on the performance: The participants walked (1) with their arms stretched out perpendicularly in the frontal plane, (2) spontaneously, i.e., without restrictions to the arm movements, and (3) with their hands on their thighs. After applying an inverse-dynamics analysis to the measured joint kinematics, we investigated the contribution of upper and lower body joints to balance regulation in terms of torque amplitude and variation. On the condition with the hands on the thighs, the contribution of the upper body remains significantly lower than the contribution of the lower body irrespective of beam widths. For spontaneous arm movements and for outstretched arms we find that the upper body (including the arms) contributes to the balancing to a similar extent as the lower body. Moreover, when the task becomes more difficult, i.e., for narrower beam widths, the contribution of the upper body increases, while the contribution of the lower body remains nearly constant. These findings lend further support to the hypothetical existence of an "upper body strategy" complementing the ankle and hip strategies especially during challenging dynamic balance tasks.

Robot-supported assessment of balance in standing and walking

Clinically useful and efficient assessment of balance during standing and walking is especially challenging in patients with neurological disorders. However, rehabilitation robots could facilitate assessment procedures and improve their clinical value. We present a short overview of balance assessment in clinical practice and in posturography. Based on this overview, we evaluate the potential use of robotic tools for such assessment. The novelty and assumed main benefits of using robots for assessment are their ability to assess 'severely affected' patients by providing assistance-as-needed, as well as to provide consistent perturbations during standing and walking while measuring the patient's reactions. We provide a classification of robotic devices on three aspects relevant to their potential application for balance assessment: 1) how the device interacts with the body, 2) in what sense the device is mobile, and 3) on what surface the person stands or walks when using the device. As examples, nine types of robotic devices are described, classified and evaluated for their suitability for balance assessment. Two example cases of robotic assessments based on perturbations during walking are presented. We conclude that robotic devices are promising and can become useful and relevant tools for assessment of balance in patients with neurological disorders, both in research and in clinical use. Robotic assessment holds the promise to provide increasingly detailed assessment that allows to individually tailor rehabilitation training, which may eventually improve training effectiveness.

Reactive stepping with functional neuromuscular stimulation in response to forward-directed perturbations

Background

Implanted motor system neuroprostheses can be effective at increasing personal mobility of persons paralyzed by spinal cord injuries. However, currently available neural stimulation systems for standing employ patterns of constant activation and are unreactive to changing postural demands.

Methods

In this work, we developed a closed-loop controller for detecting forward-directed body disturbances and initiating a stabilizing step in a person with spinal cord injury. Forward-directed pulls at the waist were detected with three body-mounted triaxial accelerometers. A finite state machine was designed and tested to trigger a postural response and apply stimulation to appropriate muscles so as to produce a protective step when the simplified jerk signal exceeded predetermined thresholds.

Results

The controller effectively initiated steps for all perturbations with magnitude between 10 and 17.5 s body weight, and initiated a postural response with occasional steps at 5% body weight. For perturbations at 15 and 17.5% body weight, the dynamic responses of the subject exhibited very similar component time periods when compared with able-bodied subjects undergoing similar postural perturbations. Additionally, the reactive step occurred faster for stronger perturbations than for weaker ones (p < .005, unequal varience t-test.)

Conclusions

This research marks progress towards a controller which can improve the safety and independence of persons with spinal cord injury using implanted neuroprostheses for standing.

Recent perspectives of cerebral palsy in children

The movement and posture disorder of cerebral palsy (CP) is presumed to mainly be a consequence of the motor disorder, but accompanying disturbances with sensations and perception have also been suggested to influence motor function. The heterogeneous condition of CP is caused by an injury to the immature brain affecting movement and posture development. The attainment of standing and walking can be difficult and an assistive device to accomplish the tasks may be required for some children with CP. In this review, we enlightened the role of possible sensory and perceptual disturbances for standing difficulties in children with CP.

Postural response characterization of standing humans to multi-directional, predictable and unpredictable perturbations to the arm

When the arm of a standing human is perturbed in an unpredictable direction, postural muscles are activated at latencies as short as 50-110ms. While the motion of the body clearly progresses in hand-to-leg sequence, there is no systematic muscle activation sequence from the arm to the leg muscles, suggesting that the activation of the muscles is not likely the result of local stretch reflexes. In fact, the lower limb muscles are activated before the upright posture is significantly disturbed. The short-latency activation amplitude and the activation probability are clearly tuned to the direction of the arm perturbation for both rostral and caudal muscles. The effect of central set on the short-latency response has been investigated by manipulating the predictability of the perturbations. Possible underlying neural mechanisms have been discussed.

Effect of acute lateral hemisection of the spinal cord on spinal neurons of postural networks

In quadrupeds, acute lateral hemisection of the spinal cord (LHS) severely impairs postural functions, which recover over time. Postural limb reflexes (PLRs) represent a substantial component of postural corrections in intact animals. The aim of the present study was to characterize the effects of acute LHS on two populations of spinal neurons (F and E) mediating PLRs. For this purpose, in decerebrate rabbits, responses of individual neurons from L5 to stimulation causing PLRs were recorded before and during reversible LHS (caused by temporal cold block of signal transmission in lateral spinal pathways at L1), as well as after acute surgical LHS at L1. Results obtained after Sur-LHS were compared to control data obtained in our previous study. We found that acute LHS caused disappearance of PLRs on the affected side. It also changed a proportion of different types of neurons on that side. A significant decrease and increase in the proportion of F- and non-modulated neurons, respectively, was found. LHS caused a significant decrease in most parameters of activity in F-neurons located in the ventral horn on the lesioned side and in E-neurons of the dorsal horn on both sides. These changes were caused by a significant decrease in the efficacy of posture-related sensory input from the ipsilateral limb to F-neurons, and from the contralateral limb to both F- and E-neurons. These distortions in operation of postural networks underlie the impairment of postural control after acute LHS, and represent a starting point for the subsequent recovery of postural functions.

Hip and ankle responses for reactive balance emerge from varying priorities to reduce effort and kinematic excursion: A simulation study

Although standing balance is important in many daily activities, there has been little effort in developing detailed musculoskeletal models and simulations of balance control compared to other whole-body motor activities. Our objective was to develop a musculoskeletal model of human balance that can be used to predict movement patterns in reactive balance control. Similar to prior studies using torque-driven models, we investigated how movement patterns during a reactive balance response are affected by high-level task goals (e.g., reducing center-of-mass movement, maintaining vertical trunk orientation, and minimizing effort). We generated 23 forward dynamics simulations where optimal muscle excitations were found using cost functions with different weights on minimizing these high-level goals. Variations in hip and ankle angles observed experimentally (peak hip flexion=7.9-53.1°, peak dorsiflexion=0.5-4.7°) could be predicted by varying the priority of these high-level goals. More specifically, minimizing center-of-mass motion produced a hip strategy (peak hip flexion and ankle dorsiflexion angles of 45.5° and 2.3°, respectively) and the response shifted towards an ankle strategy as the priority to keep the trunk vertical was increased (peak hip and ankle angles of 13.7° and 8.5°, respectively). We also found that increasing the priority to minimize muscle stress always favors a hip strategy. These results are similar to those from sagittal-plane torque-driven models. Our muscle-actuated model facilitates the investigation of neuromechanical interactions governing reactive balance control to predict muscle activity and movement patterns based on interactions between neuromechanical elements such as spinal reflexes, muscle short-range stiffness, and task-level sensorimotor feedback.

Effects of acute spinalization on neurons of postural networks

Postural limb reflexes (PLRs) represent a substantial component of postural corrections. Spinalization results in loss of postural functions, including disappearance of PLRs. The aim of the present study was to characterize the effects of acute spinalization on two populations of spinal neurons (F and E) mediating PLRs, which we characterized previously. For this purpose, in decerebrate rabbits spinalized at T12, responses of interneurons from L5 to stimulation causing PLRs before spinalization, were recorded. The results were compared to control data obtained in our previous study. We found that spinalization affected the distribution of F- and E-neurons across the spinal grey matter, caused a significant decrease in their activity, as well as disturbances in processing of posture-related sensory inputs. A two-fold decrease in the proportion of F-neurons in the intermediate grey matter was observed. Location of populations of F- and E-neurons exhibiting significant decrease in their activity was determined. A dramatic decrease of the efficacy of sensory input from the ipsilateral limb to F-neurons, and from the contralateral limb to E-neurons was found. These changes in operation of postural networks underlie the loss of postural control after spinalization, and represent a starting point for the development of spasticity.

Human upright posture control models based on multisensory inputs; in fast and slow dynamics

Posture control to maintain an upright stance is one of the most important and basic requirements in the daily life of humans. The sensory inputs involved in posture control include visual and vestibular inputs, as well as proprioceptive and tactile somatosensory inputs. These multisensory inputs are integrated to represent the body state (body schema); this is then utilized in the brain to generate the motion. Changes in the multisensory inputs result in postural alterations (fast dynamics), as well as long-term alterations in multisensory integration and posture control itself (slow dynamics). In this review, we discuss the fast and slow dynamics, with a focus on multisensory integration including an introduction of our study to investigate "internal force control" with multisensory integration-evoked posture alteration. We found that the study of the slow dynamics is lagging compared to that of fast dynamics, such that our understanding of long-term alterations is insufficient to reveal the underlying mechanisms and to propose suitable models. Additional studies investigating slow dynamics are required to expand our knowledge of this area, which would support the physical training and rehabilitation of elderly and impaired persons.

Differences in leg muscle activity and body sway between elderly adults able and unable to maintain one-leg stance for 1 min: the effect of hand support

BACKGROUND

One-leg stance (OLS) training is often used to prevent falls in the elderly. The burden imposed on the supporting lower limb during OLS may differ depending on whether hand support is used, particularly in patients with decreased lower-limb strength.

AIMS

Here we examined the effect of hand support on leg muscle activity and body sway during OLS in elderly subjects able to maintain OLS for 1 min unaided [able group (AG), n = 13] and those who were unable to do so [unable group (UG), n = 11].

METHODS

All subjects performed OLS unaided and OLS with front support (OLS-FS) using one hand for 1 min each. We estimated leg muscle activity [mean and maximum % root mean square (%RMS)] and body sway (total, X-axis, and Y-axis path lengths) for both tests. %RMS was calculated according to the results of the maximum voluntary isometric contraction test.

RESULT

The overall average mean and maximum %RMS for the tibialis anterior muscle was larger in UG than in AG. In AG, tibialis anterior muscle mean and maximum %RMS and body sway was larger during OLS than during OLS-FS. Total and X-axis path lengths were larger during the first 20 s OLS phase in AG and the first 20 s OLS-FS phase in UG.

CONCLUSION

These results highlight the need to differentiate between patients able and unable to perform OLS unaided for training because of differences in leg muscle activity.

Hatha yoga on body balance

Background:

A good body balance requires a proper function of vestibular, visual, and somatosensory systems which can be reach with exercise practice and/or yoga.

Aim:

To determine the effects of a 5-month hatha yoga training program on body balance in young adults.

Materials and Methods:

This study used a controlled, nonrandomized design, where the experimental group underwent a 5-month training program and were then compared with the control group that had a sedentary lifestyle. A convenience sample of 34 out of 40 men aged 25-55 years old (34.0 ± 0.9) were deemed eligible for this study. They were randomly divided into two groups: Experimental and control groups. Subjects in the experimental group were engaged in 60 min sessions of hatha yoga three times a week for 5 months. We evaluated postural control by measuring the limit of stability and velocity of oscillation (VOS) in three conditions of the balance rehabilitation unit (BRU) and through field procedures (four position, plane, flamingo, hopscotch, and dynamic test).

Results:

We observed differences (P < 0.05) in postintervention scores between the groups regardless of BRU parameters and field procedures (except for flamingo) even after adjusting for preintervention scores, suggesting that these changes were induced by hatha yoga training. The partial eta squared on BRU parameters ranged from 0.78 (VOS1)-0.97 (COP2), and from 0.00 (flamingo)-0.94 (four position) for the field procedures.

Conclusions:

Our results provide substantial evidence that postural control in healthy young adults can be improved through practicing hatha yoga.

Impact of forearm fatigue on the postural response to an externally initiated, predictable perturbation

PURPOSE

The objective was to examine the impact of non-postural muscle fatigue on anticipatory postural control, during postural perturbations induced by platform translations. The experimental setup investigated the central changes caused by fatigue without the potential confounding influence of peripheral fatigue within the postural muscles.

METHODS

Fatigue induced in forearm muscles by a maximal handgrip contraction has been previously shown to influence forearm force production for 10 min, reduce ankle plantarflexion force for 1 min and create measureable central fatigue for 30 s. The peak-to-peak anterior/posterior displacement of the center of mass and center of pressure (COP) and muscle activity were measured during the postural perturbation tasks performed before the fatigue protocol and for 10 min post-fatigue.

RESULTS

The fatigue protocol decreased the peak-to-peak COP displacement from 128.0 ± 12.3 mm pre-fatigue to 81.9 ± 7.8 mm post-fatigue during the forwards platform translation (p < 0.05) and from 133.8 ± 12.0 to 89.2 ± 7.9 mm during the backwards translation (p < 0.05). The fatigue protocol also caused the tibialis anterior (TA pre-fatigue = -0.25 ± 0.04 s, TA post-fatigue = -0.41 ± 0.02 s, p = 0.001) and medial gastrocnemius muscles (MG pre-fatigue = -0.39 ± 0.03 s, MG post-fatigue = -0.48 ± 0.02 s, p = 0.028) to be recruited significantly earlier relative to the pre-fatigue condition.

CONCLUSION

This experimental setup ensured that peripheral fatigue did not develop in the postural muscles; therefore, a general fatigued-induced modification of the postural strategy is proposed as the origin of the postural changes and delayed recovery.

Effects of Local Muscle Vibration on the Displacement of Center of Pressure during Quiet Standing

[Purpose] The purpose of this study was to investigate the effect of local vibration stimuli on body balance (trace area, trace length, and velocity) in healthy adults during double-leg standing. [Subjects and Methods] Thirty-nine subjects (10 male, 29 female) participated in this study. They were asked to keep their balance while holding four positions: standing with their eyes open, with and without vibration stimuli, and standing with their eyes closed, with and without vibration stimuli. The vibration stimuli, which had a duration of 30 sec, and a frequency of 60–80 Hz, were applied to the tibialis anterior and gastrocnemius muscle belly during double-leg standing. Balance measurement was performed using the Balance Trainer 4 (HUR Labs Oy, Tampere, Finland). All subjects provided informed consent prior to participation in this study. [Results] In the open-eyes position, there were no significant differences in trace area, trace length, and velocity of the center of pressure (COP) either with or without vibration stimuli. However, in the closed-eyes position, the vibration stimuli significantly decreased trace area, trace length, and velocity of the COP compared with when no vibration stimuli were applied. [Conclusion] These results suggest that vibration stimuli applied to the lower leg improve balance when a person’s eyes are closed during double-leg quiet standing.

Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury

OBJECTIVE

To determine whether alterations to the Balance Error Scoring System (BESS), such as modified conditions and/or instrumentation, would improve the ability to correctly classify traumatic brain injury (TBI) status in patients with mild TBI with persistent self-reported balance complaints.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinic.

PARTICIPANTS

Subjects (n=13; age, 16.3±2y) with a recent history of concussion (mild TBI group) and demographically matched control subjects (n=13; age, 16.7±2y; control group).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Outcome measures included the BESS, modified BESS, instrumented BESS, and instrumented modified BESS. All subjects were tested on the noninstrumented BESS and modified BESS and were scored by visual observation of instability in 6 and 3 stance conditions, respectively. Instrumentation of these 2 tests used 1 inertial sensor with an accelerometer and gyroscope to quantify bidirectional body sway.

RESULTS

Scores from the BESS and the modified BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor were significantly different between groups. The instrumented modified BESS had superior diagnostic classification and the largest area under the curve when compared with the other balance measures.

CONCLUSIONS

A concussion may disrupt the sensory processing required for optimal postural control, which was measured by sway during quiet stance. These results suggest that the use of portable inertial sensors may be useful in the move toward more objective and sensitive measures of balance control postconcussion, but more work is needed to increase sensitivity.