The integration of multiple proprioceptive information: effect of ankle tendon vibration on postural responses to platform tilt

The effects of visual information deprivation and feedback balance training on balance in patients with stroke

BACKGROUND

Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities.

OBJECTIVE

The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors.

METHODS

The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments.

RESULTS

The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance.

CONCLUSION

The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.

Fear of heights shapes postural responses to vibration-induced balance perturbation at virtual height

Introduction

Standing upright at height is a challenging situation involving intense threat of balance loss and fall. The ability to maintain balance in such conditions requires properly resolving sensory conflicts and is influenced by fear. To get more insight on the role of fear in balance control at height, we explored the dynamics of postural behavior in the situation of enhanced threat of potential balance loss.

Methods

In 40 young individuals with varying fear of heights, we combined simulated exposure to height in a virtual reality environment with bilateral vibration of tibialis anterior muscles which evokes posture destabilization (the so-called vibration-induced falling).

Results

Under such condition of enhanced postural threat, individuals with intense fear of heights showed stronger stiffening of posture compared with individuals with low fear of heights who react more flexibly and adaptively to posture destabilization. This group difference was evident already at ground level but further increased during virtual height exposure.

Discussion

Our data show that fear of height significantly affects posture adaptation to balance-destabilizing events. Our findings demonstrate that the assessment of postural behavior during threatening situations in the virtual reality environment provides valuable insights into the mechanisms of balance control and may be used to develop novel strategies aimed at prevention of falls.

Electromyographic responses to unexpected Achilles tendon vibration-induced perturbations during standing in young and older people

This study aimed to investigate age-related differences in electromyographic (EMG) responses to unexpected Achilles tendon vibration (ATV) perturbations while standing blindfold. ATV with variable and random duration (12-15 s) and rest periods (20-24 s) was applied on 18 young and 16 older volunteers. The anterior/posterior center of pressure (CoP) and the soleus (SOL) and tibialis anterior (TA) EMG were analyzed for 1 s before and 8 s after the ATV onset and offset. ATV induced a posterior shift of CoP in both groups, with more pronounced shift in the older group. During ATV onset, the older group demonstrated less SOL and more TA EMG increase compared to the young group. During the first 0.5 s of ATV offset, SOL EMG was decreased in both age groups, while TA showed a burst of EMG activity that was greater in the older group. No difference in the latencies of EMG peaks or valleys was observed between the groups. It is concluded that ATV induces greater posterior CoP shift in older adults, and they adopt a recovery strategy, characterized by a decreased SOL activation and an increased TA activation. These differences are possibly attributed to the increased fear of falling, decreased limits of stability and reduced capacity of older people to reweight their sensory inflow when proprioception is distorted.

Specific Posture-Stabilising Effects of Vision and Touch Are Revealed by Distinct Changes of Body Oscillation Frequencies

We addressed postural instability during stance with eyes closed (EC) on a compliant surface in healthy young people. Spectral analysis of the centre of foot pressure oscillations was used to identify the effects of haptic information (light-touch, EC-LT), or vision (eyes open, EO), or both (EO-LT). Spectral median frequency was strongly reduced by EO and EO-LT, while spectral amplitude was reduced by all "stabilising" sensory conditions. Reduction in spectrum level by EO mainly appeared in the high-frequency range. Reduction by LT was much larger than that induced by the vision in the low-frequency range, less so in the high-frequency range. Touch and vision together produced a fall in spectral amplitude across all windows, more so in anteroposterior (AP) direction. Lowermost frequencies contributed poorly to geometric measures (sway path and area) for all sensory conditions. The same subjects participated in control experiments on a solid base of support. Median frequency and amplitude of the spectrum and geometric measures were largely smaller when standing on solid than on foam base but poorly affected by the sensory conditions. Frequency analysis but not geometric measures allowed to disclose unique tuning of the postural control mode by haptic and visual information. During standing on foam, the vision did not reduce low-frequency oscillations, while touch diminished the entire spectrum, except for the medium-high frequencies, as if sway reduction by touch would rely on rapid balance corrections. The combination of frequency analysis with sensory conditions is a promising approach to explore altered postural mechanisms and prospective interventions in subjects with central or peripheral nervous system disorders.

Posture dependent ankle and foot muscle responses evoked by Achilles' tendon vibration

To investigate the link between the triceps surae and the intrinsic muscles of the foot, often underestimated in posture maintenance, we asked how Achilles' tendon vibration modulates the EMG activity of the soleus and flexor digitorum brevis (FDB) muscles during different postural tasks: sitting, standing and forward leaning. Young healthy participants (n = 19, age = 24 ± 7.4 years) stood for 60 s in three visually controlled postures, while vibration (1.5-1.8 mm, 80 Hz) was bilaterally applied over the Achilles' tendon during the middle 20 s. Center of Pressure (CoP) and EMG activity of the soleus and FDB muscle were summarized in 5 s epochs and compared across time (before, during and after vibration) and postural tasks. Achilles' tendon vibration shifted the CoP position forward in sitting and backward in standing and leaning and increased the root mean square of the CoP velocity to a greater extent in standing and leaning compared to sitting. Soleus and FDB EMG amplitude also increased in response to vibration. These responses were posture dependent, being greater in standing (soleus: 57 %, FDB: 67 % relative to pre-vibration) compared to sitting (soleus: 36 %, FDB: 27 % relative to pre-vibration) and leaning (soleus: 26 %, FDB: 8% relative to pre-vibration). After vibration offset, both soleus and FDB showed sustained activation across all three postures. Results highlight the presence of Ia afferent projections from the soleus to the α motor neurons of the FDB muscle triggered by Achilles' tendon vibration. This link is posture dependent serving a functional role in standing and forward leaning in the presence of externally applied perturbations.

Time course and variability of tendinous vibration-induced postural reactions in forward and backward directions

Mechanical vibration of tendons induces large postural reactions (PR-VIB) but little is known about how these reactions vary within and between subjects. We investigated the intra- and inter-individual variability of PR-VIB and determined the reliability of center of pressure (COP) measures. Bipodal postural control (eyes closed) of 30 healthy adults were evaluated using a force platform under 02 conditions: bilateral VIB of the tibialis anterior (TA) and Achilles tendons (ACH-T) at 80 Hz. Each condition consisted of 03 trials of 30 s duration (Baseline: 10 s; VIB: 10 s; POST-VIB: 10 s). The Amplitude and Velocity of the COP in the antero-posterior/medio-lateral (AP/ML) directions were recorded and analyzed according to 5 time-windows incremented every 2 s of vibration (i.e. the first 2 s; 4 s; 6 s; 8 s & 10 s), whereas the COP position/AP was monitored every 0.5 s. All postural parameters increased significantly during TA and ACH-T vibration compared to the Baseline. The reliability of the COP measures showed good ICC scores (0.40-0.84) and measurement errors that varied depending on the duration of VIB time-windows. The COP position/AP reveals a lower intra- and inter-subject variability of PR-VIB in the first 2 s of VIB. The metrological characteristics of PR-VIB should be investigated further to guide their future use by clinicians and researchers.

Multi-Sensorimotor Training Improves Proprioception and Balance in Subacute Stroke Patients: A Randomized Controlled Pilot Trial

Introduction: The objective was to determine whether advanced rehabilitation therapy combined with conventional rehabilitation therapy consisting of sensorimotor exercises would be superior to usual treadmill training for proprioception variation and balance ability in subacute stroke patients.

Methods: Thirty subjects (post-stroke time period: 3.96 ± 1.19 months) were randomly assigned to either a multi-sensorimotor training group (n = 19) or a treadmill training group (n = 18). Both groups first performed conventional physical therapy for 30 min, after which the multi-sensorimotor training group performed multi-sensorimotor training for 30 min, and the treadmill training group performed treadmill gait training for 30 min. Both groups performed the therapeutic interventions 5 days per week for 8 weeks. The primary outcome (proprioception variation) was evaluated using an acryl panel and electrogoniometer. The secondary outcome (balance ability) was measured using the Biodex Balance system before intervention and after 8 weeks.

Results: The multi-sensorimotor training and treadmill training groups showed significant improvement in proprioception variation and balance (overall, A-P and M-L) (all P < 0.05). In particular, the multi-sensorimotor training group showed more significant differences in proprioception variation (P = 0.002) and anterior-posterior (A-P) balance ability (P = 0.033) than the treadmill training group.

Conclusions: The multi-sensorimotor training program performed on multiple types of sensory input had a beneficial effect on proprioception sense in the paretic lower limb and A-P balance. A large-scale randomized controlled study is needed to prove the effect of this training.

Clinical Trial Registration:https://cris.nih.go.kr/cris/, identifier KCT0003097.

Putting proprioception for balance to the test: Contrasting and combining sway referencing and tendon vibration

BACKGROUND

Postural control relies on sensory information from visual, vestibular and proprioceptive channels, with proprioception being the key sensory modality in this task. Two well-established ways of manipulating proprioceptive information in postural control are tendon vibration and sway referencing. The aim of the present study was to assess postural adaptation when inaccurate proprioceptive information is introduced using tendon vibration and sway referencing in isolation and combination.

METHODS

Seventeen young adults were asked to stand, without vision, for 2 min on a fixed surface (baseline) immediately followed by 3 min of bilateral Achilles tendon vibration, sway reference, or combined presentation of the two manipulations (adaptation) and finally 3 min of standing on a fixed surface (aftereffect).

RESULTS

During adaptation, vibration showed the lowest sway variability, followed by sway reference and the combined condition. Spectral analyses focusing on the dominant frequencies in this task (0-0.4 Hz) showed that in the first half of adaptation sway amplitude was greater when the two manipulations were combined compared with each manipulation alone. However, in the second half differences between sway reference and the combined condition disappeared but differences between vibration and the other two conditions increased.

CONCLUSION

We interpret these findings primarily as due to a prolonged attenuation in effects of vibration over the course of the adaptation phase and we offer two explanations for this phenomenon. One is a decline in neurotransmitter release from the group Ia terminals and the other is sensory reweighting which down-weights proprioception and up-weights the accurate, vestibular information.

Effects of White Noise Achilles Tendon Vibration on Quiet Standing and Active Postural Positioning

Applying white noise vibration to the ankle tendons has previously been used to improve passive movement detection and alter postural control, likely by enhancing proprioceptive feedback. The aim of the present study was to determine if similar methods focused on the ankle plantarflexors affect the performance of both quiet standing and an active postural positioning task, in which participants may be more reliant on proprioceptive feedback from actively contracting muscles. Twenty young, healthy participants performed quiet standing trials and active postural positioning trials designed to encourage reliance on plantarflexor proprioception. Performance under normal conditions with no vibration was compared to performance with 8 levels of vibration amplitude applied to the bilateral Achilles tendons. Vibration amplitude was set either as a percentage of sensory threshold (n = 10) or by root-mean-square (RMS) amplitude (n = 10). No vibration amplitude had a significant effect on quiet standing. In contrast, accuracy of the active postural positioning task was significantly (P = .001) improved by vibration with an RMS amplitude of 30 μm. Setting vibration amplitude based on sensory threshold did not significantly affect postural positioning accuracy. The present results demonstrate that appropriate amplitude tendon vibration may hold promise for enhancing the use of proprioceptive feedback during functional active movement.

Balancing sensory inputs: Sensory reweighting of ankle proprioception and vision during a bipedal posture task

During multisensory integration, it has been proposed that the central nervous system (CNS) assigns a weight to each sensory input through a process called sensory reweighting. The outcome of this integration process is a single percept that is used to control posture. The main objective of this study was to determine the interaction between ankle proprioception and vision during sensory integration when the two inputs provide conflicting sensory information pertaining to direction of body sway. Sensory conflict was created by using bilateral Achilles tendon vibration and contracting visual flow and produced body sway in opposing directions when applied independently. Vibration was applied at 80Hz, 1mm amplitude and the visual flow consisted of a virtual reality scene with concentric rings retreating at 3m/s. Body sway elicited by the stimuli individually and in combination was evaluated in 10 healthy young adults by analyzing center of pressure (COP) displacement and lower limb kinematics. The magnitude of COP displacement produced when vibration and visual flow were combined was found to be lesser than the algebraic sum of COP displacement produced by the stimuli when applied individually. This suggests that multisensory integration is not merely an algebraic summation of individual cues. Instead the observed response might be a result of a weighted combination process with the weight attached to each cue being directly proportional to the relative reliability of the cues. The moderating effect of visual flow on postural instability produced by vibration points to the potential use of controlled visual flow for balance training.

Effects of tibialis anterior vibration on postural control when exposed to support surface translations

The sensory re-weighting theory suggests unreliable inputs may be down-weighted to favor more reliable sensory information and thus maintain proper postural control. This study investigated the effects of tibialis anterior (TA) vibration on center of pressure (COP) motion in healthy individuals exposed to support surface translations to further explore the concept of sensory re-weighting. Twenty healthy young adults stood with eyes closed and arms across their chest while exposed to randomized blocks of five trials. Each trial lasted 8 s, with TA vibration either on or off. After 2 s, a sudden backward or forward translation occurred. Anterior-posterior (A/P) COP data were evaluated during the preparatory (first 2 s), perturbation (next 3 s), and recovery (last 3 s) phases to assess the effect of vibration on perturbation response features. The knowledge of an impending perturbation resulted in reduced anterior COP motion with TA vibration in the preparatory phase relative to the magnitude of anterior motion typically observed during TA vibration. During the perturbation phase, vibration did not influence COP motion. However, during the recovery phase vibration induced greater anterior COP motion than during trials without vibration. The fact that TA vibration produced differing effects on COP motion depending upon the phase of the perturbation response may suggest that the immediate context during which postural control is being regulated affects A/P COP responses to TA vibration. This indicates that proprioceptive information is likely continuously re-weighted according to the context in order to maintain effective postural control.

Time-interval for integration of stabilizing haptic and visual information in subjects balancing under static and dynamic conditions

Maintaining equilibrium is basically a sensorimotor integration task. The central nervous system (CNS) continually and selectively weights and rapidly integrates sensory inputs from multiple sources, and coordinates multiple outputs. The weighting process is based on the availability and accuracy of afferent signals at a given instant, on the time-period required to process each input, and possibly on the plasticity of the relevant pathways. The likelihood that sensory inflow changes while balancing under static or dynamic conditions is high, because subjects can pass from a dark to a well-lit environment or from a tactile-guided stabilization to loss of haptic inflow. This review article presents recent data on the temporal events accompanying sensory transition, on which basic information is fragmentary. The processing time from sensory shift to reaching a new steady state includes the time to (a) subtract or integrate sensory inputs; (b) move from allocentric to egocentric reference or vice versa; and (c) adjust the calibration of motor activity in time and amplitude to the new sensory set. We present examples of processes of integration of posture-stabilizing information, and of the respective sensorimotor time-intervals while allowing or occluding vision or adding or subtracting tactile information. These intervals are short, in the order of 1–2 s for different postural conditions, modalities and deliberate or passive shift. They are just longer for haptic than visual shift, just shorter on withdrawal than on addition of stabilizing input, and on deliberate than unexpected mode. The delays are the shortest (for haptic shift) in blind subjects. Since automatic balance stabilization may be vulnerable to sensory-integration delays and to interference from concurrent cognitive tasks in patients with sensorimotor problems, insight into the processing time for balance control represents a critical step in the design of new balance- and locomotion training devices.

Test-retest reliability of muscle vibration effects on postural sway

The effect of alterations in the processing of proprioceptive signals, on postural control, has been studied using muscle vibration effects. However, reliability and agreement of muscle vibration have still to be addressed. This study aimed to assess intra- and interday reliability and agreement of vibration effects of lumbar paraspinal and triceps surae muscles in a non-selected sample of 20 subjects, standing on solid surface and on foam. We used mean position and velocity of Centre of Pressure (CoP), during and after vibration to quantify the effect of muscle vibration. We also calculated the ratio of vibration effects on the lumbar paraspinal and triceps surae muscles (proprioceptive weighting). Displacement of the CoP during vibration showed good reliability (ICCs>0.6), and proprioceptive weighting of displacement fair to good reliability (0.52-0.73). Agreement measures were poor, with most CV's ranging between 18% and 36%. Change in CoP velocity appeared not to be reliable. Balance recovery, when based on CoP position and calculated a short period after cessation of vibration, showed good reliability. According to this study, displacement during vibration, proprioceptive weighting and selected recovery variables are the most reliable indicators of the response to muscle vibration.

A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke

Spasticity management is pivotal for achieving functional recovery of stroke patients. The purpose of this study was to investigate the effects of a single trial of transcutaneous electrical nerve stimulation (TENS) on spasticity and balance in chronic stroke patients. Forty-two chronic stroke patients were randomly allocated into the TENS (n = 22) or the placebo-TENS (n = 20) group. TENS stimulation was applied to the gastrocnemius for 60 min at 100 Hz, 200 µs with 2 to 3 times the sensory threshold (the minimal threshold in detecting electrical stimulation for subjects) after received physical therapy for 30 min. In the placebo-TENS group, electrodes were placed but no electrical stimulation was administered. For measuring spasticity, the resistance encountered during passive muscle stretching of ankle joint was assessed using the Modified Ashworth Scale, and the Hand held dynamometer was used to assess the resistive force caused by spasticity. Balance ability was measured using a force platform that measures postural sway generated by postural imbalance. The TENS group showed a significantly greater reduction in spasticity of the gastrocnemius, compared to the placebo-TENS group (p < 0.05). TENS resulted in greater balance ability improvements, especially during the eyes closed condition (p < 0.05). However, these effects returned to baseline values within one day. This study shows that TENS provides an immediately effective means of reducing spasticity and of improving balance in chronic stroke patients. The present data may be useful to establish the standard parameters for TENS application in the clinical setting of stroke.

The effects of repetitive haemarthrosis on postural balance in children with haemophilia

Sensory information from visual, vestibular and proprioceptive systems is necessary to control posture and balance. Impairment in proprioception due to repetitive joints bleeding may lead to a deficit in postural balance which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase in attention in this field during the past few years, the data concerning to how bleeds can affect postural control in children with haemophilia (CWH) remain scarce. This study aimed to evaluate the postural balance in CWH. Twenty CWH Haemophilia Group (HG) and 20 age-matched children Control Group (CG) were recruited to this study. A force plate was used to record centre of pressure (COP) displacement under four different postural conditions during quiet standing: eyes open on firm surface, eyes open on foam surface, eyes closed on firm surface and eyes closed on a foam surface. Variables of COP as sway area and mean velocity and in anterior-posterior (y) medio-lateral (x) direction were processed and for each variable sensory, quotients were calculated and compared between groups. No differences were found in visual and vestibular quotients variables between groups. A higher value was found in sway area variable on proprioception quotient in the HG when compared with CG (P = 0.042). CWH with repetitive joint bleed on lower limbs showed differences in postural balance when compared with non-haemophiliac children. The identification of early balance impairments in CWH can help us understand better the effects of bleeds inside joints on postural control and plan a more effective preventive and rehabilitative treatment.

Interaction of support surface stability and Achilles tendon vibration during a postural adaptation task

Orchestration of sensory-motor information and adaptation to internal or external, acute or chronic changes is one of the fundamental features of human postural control. The postural control system is challenged on a daily basis, and displays a remarkable ability to adapt to both long and short term challenges. To explore the interaction between support surface stability and Achilles tendon vibration during a period of adaptation we used both a linear measure and a non-linear measure derived from center-of-pressure (COP) data. An equilibrium score (ES), based upon peak amplitude of anterior-posterior sway towards theoretical limits of stability was the linear measure used to assess postural performance. We observed early effects of vibration on postural stability, depending on support characteristics. Participants were able to decrease sway with extended practice over days, independent of support surface stability. Approximate entropy analysis of COP data provided additional information about control adaptation processes.

Responses of vestibular nucleus neurons to inputs from the hindlimb are enhanced following a bilateral labyrinthectomy

Vestibular nucleus neurons have been shown to respond to stimulation of afferents innervating the limbs. However, a limitation in the potential translation of these findings is that they were obtained from decerebrate or anesthetized animals. The goal of the present study was to determine whether stimulation of hindlimb nerves similarly affects vestibular nucleus neuronal activity in conscious cats, and whether the responsiveness of neurons to the stimuli is altered following a bilateral labyrinthectomy. In labyrinth-intact animals, the firing rate of 24/59 (41%) of the neurons in the caudal vestibular nucleus complex was affected by hindlimb nerve stimulation. Most responses were excitatory; the median response latency was 20 ms, but some units had response latencies as short as 10 ms. In the first week after a bilateral labyrinthectomy, the proportion of vestibular nucleus neurons that responded to hindlimb nerve stimulation increased slightly (to 24/55 or 44% of units). However, during the subsequent postlabyrinthectomy survival period, the proportion of vestibular nucleus neurons with hindlimb inputs increased significantly (to 30/49 or 61% of units). Stimuli to hindlimb nerves needed to elicit neuronal responses was consistently over three times the threshold for eliciting an afferent volley. These data show that inputs from hindlimb afferents smaller than those innervating muscle spindles and Golgi tendon organs affect the processing of information in the vestibular nuclei, and that these inputs are enhanced following a bilateral labyrinthectomy. These findings have implications for the development of a limb neuroprosthetics device for the management of bilateral vestibular loss.

Kinematic Parameters That Influence the Aesthetic Perception of Beauty in Contemporary Dance

Some experiments have stablished that certain kinematic parameters can influence the subjective aesthetic perception of the dance audience. Neave, McCarty, Freynik, Caplan, Hönekopp, and Fink (2010, Biology Letters 7 221–224) reported eleven movement parameters in non-expert male dancers, showing a significant positive correlation with perceived dance quality. We aim to identify some of the kinematic parameters of expert dancers' movements that influence the subjective aesthetic perception of observers in relation to specific skills of contemporary dance. Four experienced contemporary dancers performed three repetitions of four dance-related motor skills. Motion was captured by a VICON-MX system. The resulting 48 animations were viewed by 108 observers. The observers judged beauty using a semantic differential. The data were then subjected to multiple factor analysis. The results suggested that there were strong associations between higher beauty scores and certain kinematic parameters, especially those related to amplitude of movement.

Postural control in response to an external perturbation: effect of altered proprioceptive information

The purpose of the study was to investigate the role of altered proprioception on anticipatory (APAs) and compensatory (CPAs) postural adjustments and their interaction. Nine healthy adults were exposed to external perturbations induced at the shoulder level while standing with intact or altered proprioception induced by bilateral Achilles tendon vibration. Visual information was altered (eyes open or closed) in both the conditions. Electrical activity of eight trunk and leg muscles and center of pressure (COP) displacements were recorded and quantified within the time intervals typical for APAs and CPAs. The results showed that when proprioceptive information was altered in eyes-open conditions, anticipatory muscle activity was delayed. Moreover, altered proprioceptive information resulted in smaller magnitudes of compensatory muscle activity as well as smaller COP displacements after the perturbation in both eyes-open and eyes-closed conditions. The outcome of the study provides information on the interaction between APAs and CPAs in the presence of altered proprioception.

The effect of vibration on postural response of Down syndrome individuals on the seesaw

In order to better understand the role of proprioception in postural adjustments on unstable surfaces, we analyzed the effect of vibration on the pattern of muscle activity and joint displacements (ankle, knee and hip) of eight intellectually normal participants (control group-CG) and eight individuals with Down syndrome (DS) while balancing on seesaws of different heights. The individuals with DS adopted a pattern of co-contraction and were not able to modulate the magnitude of postural response with the seesaw's height. The vibration affected neither the ability of individuals with DS to maintain balance nor the pattern of muscle contraction. On the other hand the control group changed the strategy with vibration, adopting one similar to that used by individuals with DS. Collectively, our findings suggest that proprioceptive information is essential for the motor control system to select the appropriate motor strategy of reciprocal activation among the agonist and antagonist to efficiently balance. Also, these findings suggest that a proprioceptive deficit could explain the atypical motor strategy observed in individuals with DS during balance on seesaw.

Interaction between vision and neck proprioception in the control of stance

Balance control depends on the interaction of multiple inputs originating from different sensory systems. Here, we investigated the effect on quiet human stance of changing the visual condition prior to a proprioceptive perturbation produced by vibration of dorsal neck muscles. In complete absence of visual references, the amplitude of the postural responses to neck vibration (forward shift of the centre of foot pressure) was the largest and became progressively larger as a function of the repetition of administered stimuli. The posture-destabilizing effect of vibration eyes-closed (EC) and the build-up effect were reduced if vibration was preceded by a period during which vision was allowed (EO). Similarly, the small destabilizing effect of vibration EO was increased if vibration was preceded by an EC period. The fore-period must last more than 3 s in order to affect the response to neck muscle vibration. The responsiveness to a proprioceptive disturbing input does not immediately change on adding or subtracting vision, but a finite time period must elapse before the postural "set" defined by vision is fully established. The findings underline the importance of time when vision is used in re-weighting the excitability of the postural control mechanisms.

Locomotor adaptation and aftereffects in patients with reduced somatosensory input due to peripheral neuropathy

We studied 12 peripheral neuropathy patients (PNP) and 13 age-matched controls with the "broken escalator" paradigm to see how somatosensory loss affects gait adaptation and the release and recovery ("braking") of the forward trunk overshoot observed during this locomotor aftereffect. Trunk displacement, foot contact signals, and leg electromyograms (EMGs) were recorded while subjects walked onto a stationary sled (BEFORE trials), onto the moving sled (MOVING or adaptation trials), and again onto the stationary sled (AFTER trials). PNP were unsteady during the MOVING trials, but this progressively improved, indicating some adaptation. During the after trials, 77% of control subjects displayed a trunk overshoot aftereffect but over half of the PNP (58%) did not. The PNP without a trunk aftereffect adapted to the MOVING trials by increasing distance traveled; subsequently this was expressed as increased distance traveled during the aftereffect rather than as a trunk overshoot. This clear separation in consequent aftereffects was not seen in the normal controls suggesting that, as a result of somatosensory loss, some PNP use distinctive strategies to negotiate the moving sled, in turn resulting in a distinct aftereffects. In addition, PNP displayed earlier than normal anticipatory leg EMG activity during the first after trial. Although proprioceptive inputs are not critical for the emergence or termination of the aftereffect, somatosensory loss induces profound changes in motor adaptation and anticipation. Our study has found individual differences in adaptive motor performance, indicative that PNP adopt different feed-forward gait compensatory strategies in response to peripheral sensory loss.

Influence of expectation on postural disturbance evoked by proprioceptive stimulation

Recent experiments have shown that the vestibular channel of balance control differs fundamentally from the visual channel. Whereas the response to a visual perturbation can be suppressed if the subject has awareness that an upcoming disturbance is likely to be caused by an external agent rather than by self-motion, a similar assumption cannot be made concerning the vestibular system. The present experiment investigated whether postural responses evoked by a proprioceptive perturbation (vibration of the Achilles' tendon at 90 Hz for 2.2 s) are either automatic and immune to expectation (similarly to vestibular responses) or cognitively penetrable (similarly to visual responses). Subjects (n = 12) stood on a force platform while stimuli were delivered either by the subject himself (self-triggered condition) or by the experimenter. For the latter condition, the stimulus was delivered either without warning (unpredictable condition) or at a fixed interval (500 ms) following an auditory cue (precue condition). Results showed that the backward CoP displacement induced by vibration was delayed by approximately 500 ms in the expected and self-triggered conditions compared to the unexpected condition. However, once initiated, the velocity of the backward displacement was higher in the self-triggered condition as compared to the unexpected condition. After a period of 2.2 s of vibration, the amplitude of this backward CoP displacement was similar in the three experimental conditions. Therefore, although expectation appears to delay the upcoming of the main backward body sway, it does not appear to be able to weight the impact of the proprioceptive stimulation. This suggested that afferents provided by the different sensory channels involved in postural control are not similarly susceptible to high level processes such as expectation.

Learning Effects of Repetitive Administrations of the Sensory Organization Test in Healthy Young Adults

OBJECTIVES

To evaluate the learning effect of multiple administrations of the Sensory Organization Test (SOT) on performance and to begin to establish clinical meaningful change scores for the SOT.

DESIGN

Descriptive case series.

SETTING

University-affiliated clinic.

PARTICIPANTS

Healthy young adults (6 men, 7 women; mean age, 24+/-4y).

INTERVENTION

All subjects performed the standardized SOT using the SMART EquiTest 5 times over a 2-week period, and 1 month later.

MAIN OUTCOME MEASURE

Composite and individual SOT test condition standardized equilibrium scores.

RESULTS

Test-retest reliability (intraclass correlation coefficient model 2,3) of the composite (.67) and equilibrium score (range, .35-.79) were fair to good. Repeated-measures analysis of variance revealed a significant (P<.05) increase in the composite and equilibrium scores for conditions 4, 5, and 6 over the 5 sessions that plateaued after the third session, and were retained at 1 month. The 95% confidence interval for the composite score change from session 1 to session 4, the plateau of the learning effect, was 3.9 to 8.1.

CONCLUSIONS

Although the findings of this study would indicate that multiple baseline measures are desirable for the more challenging conditions, a composite change of greater than 8 points would indicate change due to rehabilitation.

Factors Affecting the Common Modulation of Bilateral Motor Unit Discharge in Human Soleus Muscles

The purpose of this study was to determine the factors that influence the co-modulation of motor unit discharge rate in soleus muscles of both legs during upright standing. Single motor units were recorded from the left and right soleus muscles under three experimental conditions: standing quietly with the eyes open and closed, standing with the eyes closed while vibration was applied to one Achilles tendon, and swaying voluntarily or producing variable low-force isometric contractions at a frequency of 0.05 Hz. Correlations in motor unit discharge rate between left and right soleus motor units were assessed using common drive analysis. The results showed that common drive to motoneurons of the two muscles did not differ between standing with the eyes open or closed, but there was an order effect with the second task having significantly lower common drive than the first. Common drive was also significantly lower when vibration was applied to one leg compared with when no vibration was applied. Common drive was higher as subjects swayed anteriorly as compared with when they swayed posteriorly. There were no significant differences in common drive across phases of the variable isometric force contraction. Common drive was higher during voluntary sway than during variable force production; both of these values were significantly lower than those derived from the quiet standing task. These results suggest that proprioceptive and sub-cortical inputs contribute to the co-modulation of the firing rate of soleus motor unit pairs of the left and right leg during standing posture.

Dimensional reduction in sensorimotor systems: a framework for understanding muscle coordination of posture

The simple act of standing up is an important and essential motor behavior that most humans and animals achieve with ease. Yet, maintaining standing balance involves complex sensorimotor transformations that must continually integrate a large array of sensory inputs and coordinate multiple motor outputs to muscles throughout the body. Multiple, redundant local sensory signals are integrated to form an estimate of a few global, task-level variables important to postural control, such as body center of mass (CoM) position and body orientation with respect to Earth-vertical. Evidence suggests that a limited set of muscle synergies, reflecting preferential sets of muscle activation patterns, are used to move task-variables such as CoM position in a predictable direction following postural perturbations. We propose a hierarchical feedback control system that allows the nervous system the simplicity of performing goal-directed computations in task-variable space, while maintaining the robustness afforded by redundant sensory and motor systems. We predict that modulation of postural actions occurs in task-variable space, and in the associated transformations between the low-dimensional task-space and high-dimensional sensor and muscle spaces. Development of neuromechanical models that reflect these neural transformations between low- and high-dimensional representations will reveal the organizational principles and constraints underlying sensorimotor transformations for balance control, and perhaps motor tasks in general. This framework and accompanying computational models could be used to formulate specific hypotheses about how specific sensory inputs and motor outputs are generated and altered following neural injury, sensory loss, or rehabilitation.

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

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

TENS to the posterior aspect of the legs decreases postural sway during stance

The purpose of this study was to examine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) applied to the posterior aspect of the legs, on postural sway during stance. Thirty healthy subjects were tested while standing on a force platform under four stimulation conditions: no TENS, bilateral TENS, and unilateral left and right TENS. Thirty-second long tests, employing detection threshold amplitudes, were performed in three blocks. In each block, the four conditions were applied both with and without vision in a random order. The results indicate that the application of TENS brought about a decrease in postural sway as expressed by average sway velocity, in addition to a decrease in the absolute values of maximal and minimal medio-lateral and anterior-posterior velocity. Thus, similar to sub-threshold random electrical noise, it appears that the application of low-amplitude TENS to the lower limbs decreases postural sway during stance. Considering the ease of TENS application and the high prevalence of postural disorders, the potential clinical significance of this observation is to be determined by further studies.

Head stabilization on a continuously oscillating platform: the effect of a proprioceptive disturbance on the balancing strategy

When standing and balancing on a continuously and predictably moving platform, body equilibrium relies on both anticipatory control and proprioceptive feedback. We have vibrated different postural muscles of the body to assess any effect of confounding the proprioceptive input on balance during such unstable conditions. Low and high platform oscillation frequencies were used, because different strategies are used to withstand the two perturbations. Eyes open (EO) and closed (EC) conditions were also tested, to assess whether the stabilizing effect of vision is independent from the proprioceptive disturbance. Subjects (n = 14) performed two series of trials, EO and EC: (1) quiet erect stance, (2) stance on the platform translating at 0.2 or 0.6 Hz sinusoidally in the anteroposterior (A-P) direction (dynamic conditions). Continuous bilateral vibration (90 Hz) was produced by two vibrators fixed to the following homonymous muscles: dorsal neck, quadriceps, biceps femoris, tibialis anterior, and triceps surae. Acquisition of body segments' displacement began 10 s after the start of platform translation. From markers fixed to head, hip, and malleolus, we computed the A-P oscillation of head and hip, body orientation in space, and cross-correlation (CC) and time-delay between malleolus and head trajectories. The results were (a) the head A-P oscillation was smaller with EO than EC, under both quiet stance and dynamic conditions; (b) vibration of tibialis and triceps surae, but not of other muscles, slightly increased head and body A-P oscillation with EC under dynamic conditions; (c) at 0.2 Hz but not at 0.6 Hz, for all visual and vibration conditions, there was a significant association between head and feet; (d) at 0.2 Hz, EC, neck muscle vibration increased this association, whereas vibration of the other muscles induced a major time delay in the oscillation of head compared with feet; (e) vibration of either neck or tibialis induced forward body leaning, while vibration of either triceps surae or biceps femoris induced backward leaning, with both EO and EC, under both static and dynamic conditions; (f) the head A-P oscillation, however, under dynamic conditions was not dependent on body leaning. The relatively scarce effects of proprioceptive disturbance on head stabilization and multijoint coordination (in spite of effects on body orientation similar to those observed during stance) speak for a major role of anticipatory control in the dynamic equilibrium task. However, the significant vibration-induced time delay in segments' coordination at low translation frequency, EC, suggests that the normally patterned Ia input promotes continuous adjustments of the feed-forward control mode.