Rapid adaptation of torso pointing movements to perturbations of the base of support

Between-site equivalence of turning speed assessments using inertial measurement units

BACKGROUND

Turning is a component of gait that requires planning for movement of multiple body segments and the sophisticated integration of sensory information from the vestibular, visual, and somatosensory systems. These aspects of turning have led to growing interest to quantify turning in clinical populations to characterize deficits or identify disease progression. However, turning may be affected by environmental differences, and the degree to which turning assessments are comparable across research or clinical sites has not yet been evaluated.

RESEARCH QUESTION

The aim of this study was to determine the extent to which peak turning speeds are equivalent between two sites for a variety of mobility tasks.

METHODS

Data were collected at two different sites using separate healthy young adult participants (n = 47 participants total), but recruited using identical inclusion and exclusion criteria. Participants at each site completed three turning tasks: a one-minute walk (1 MW) along a six-meter walkway, a modified Illinois Agility Test (mIAT), and a custom clinical turning course (CCTC). Peak yaw turning speeds were extracted from wearable inertial sensors on the head, trunk, and pelvis. Between-site differences and two one-sided tests (TOST) were used to determine equivalence between sites, based on a minimum effect size reported between individuals with mild traumatic brain injury and healthy control subjects.

RESULTS

No outcomes were different between sites, and equivalence was determined for 6/21 of the outcomes. These findings suggest that some turning tasks and outcome measures may be better suited for multi-site studies. The equivalence results are also dependent on the minimum effect size of interest; nearly all outcomes were equivalent across sites when larger minimum effect sizes of interest were used.

SIGNIFICANCE

Together, these results suggest some tasks and outcome measures may be better suited for multi-site studies and literature-based comparisons.

Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI.

Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.

Did I do that? Detecting a perturbation to visual feedback in a reaching task

The motor system executes actions in a highly stereotyped manner despite the high number of degrees of freedom available. Studies of motor adaptation leverage this fact by disrupting, or perturbing, visual feedback to measure how the motor system compensates. To elicit detectable effects, perturbations are often large compared to trial-to-trial reach endpoint variability. However, awareness of large perturbations can elicit qualitatively different compensation processes than unnoticeable ones can. The current experiment measures the perturbation detection threshold, and investigates how humans combine proprioception and vision to decide whether displayed reach endpoint errors are self-generated only, or are due to experimenter-imposed perturbation. We scaled or rotated the position of the visual feedback of center-out reaches to targets and asked subjects to indicate whether visual feedback was perturbed. Subjects detected perturbations when they were at least 1.5 times the standard deviation of trial-to-trial endpoint variability. In contrast to previous studies, subjects suboptimally combined vision and proprioception. Instead of using proprioceptive input, they responded based on the final (possibly perturbed) visual feedback. These results inform methodology in motor system experimentation, and more broadly highlight the ability to attribute errors to one's own motor output and combine visual and proprioceptive feedback to make decisions.

Abnormal Turning and Its Association with Self-Reported Symptoms in Chronic Mild Traumatic Brain Injury

Turning is common in daily activity and requires rapid, coordinated reorientation of the head, trunk, and pelvis toward the new direction of travel. Yet, turning gait has not been well explored in populations with mild traumatic brain injury (mTBI) who may alter their turning behavior according to self-perceived symptoms or motor dysfunction. The purpose of this study was to examine turning velocities and coordination in adults with chronic mTBI (>3 months post-injury and still reporting balance complaints) during a task simulating everyday ambulation. We hypothesized that individuals with chronic mTBI would reduce their angular velocity when turning and increase the variability of head-pelvis coordination compared with controls, and that the reduction in velocity and increased variability would be associated with their self-reported symptom score. Forty-two adults (14 chronic mTBI, 28 controls) completed the Neurobehavioral Symptom Inventory before walking 12 laps around a marked course containing two 45-degree turns, four 90-degree turns, and two 135-degree turns. Inertial sensors collected angular velocities of the head and pelvis. After adjusting for covariates, participants with chronic mTBI had significantly slower lap times and peak angular velocities of the pelvis (p < 0.01) compared with the control group. The peak velocity timing (PVT) between peak velocities of the head and pelvis, and the variability of that timing was significantly greater in participants with chronic mTBI (p < 0.01). Within the chronic mTBI group, somatosensory symptoms were associated with slower angular velocities of the head and pelvis (p = 0.03) and increased PVT variability (p < 0.01). The results suggest individuals with chronic mTBI with worse somatic symptoms have impaired head stabilization during turning in situations similar to everyday life. These results encourage future research on turning gait to examine the causal relationship between symptoms and daily locomotor function in adults with chronic mTBI.

Sinusoidal error perturbation reveals multiple coordinate systems for sensorymotor adaptation

A coordinate system is composed of an encoding, defining the dimensions of the space, and an origin. We examine the coordinate encoding used to update motor plans during sensory-motor adaptation to center-out reaches. Adaptation is induced using a novel paradigm in which feedback of reach endpoints is perturbed following a sinewave pattern over trials; the perturbed dimensions of the feedback were the axes of a Cartesian coordinate system in one session and a polar coordinate system in another session. For center-out reaches to randomly chosen target locations, reach errors observed at one target will require different corrections at other targets within Cartesian- and polar-coded systems. The sinewave adaptation technique allowed us to simultaneously adapt both dimensions of each coordinate system (x-y, or reach gain and angle), and identify the contributions of each perturbed dimension by adapting each at a distinct temporal frequency. The efficiency of this technique further allowed us to employ perturbations that were a fraction the size normally used, which avoids confounding automatic adaptive processes with deliberate adjustments made in response to obvious experimental manipulations. Subjects independently corrected errors in each coordinate in both sessions, suggesting that the nervous system encodes both a Cartesian- and polar-coordinate-based internal representation for motor adaptation. The gains and phase lags of the adaptive responses are not readily explained by current theories of sensory-motor adaptation.

Adaptation to Coriolis perturbations of voluntary body sway transfers to preprogrammed fall-recovery behavior

In a rotating environment, goal-oriented voluntary movements are initially disrupted in trajectory and endpoint, due to movement-contingent Coriolis forces, but accuracy is regained with additional movements. We studied whether adaptation acquired in a voluntary, goal-oriented postural swaying task performed during constant-velocity counterclockwise rotation (10 RPM) carries over to recovery from falling induced using a hold and release (H&R) paradigm. In H&R, standing subjects actively resist a force applied to their chest, which when suddenly released results in a forward fall and activation of an automatic postural correction. We tested H&R postural recovery in subjects (n = 11) before and after they made voluntary fore-aft swaying movements during 20 trials of 25 s each, in a counterclockwise rotating room. Their voluntary sway about their ankles generated Coriolis forces that initially induced clockwise deviations of the intended body sway paths, but fore-aft sway was gradually restored over successive per-rotation trials, and a counterclockwise aftereffect occurred during postrotation attempts to sway fore-aft. In H&R trials, we examined the initial 10- to 150-ms periods of movement after release from the hold force, when voluntary corrections of movement path are not possible. Prerotation subjects fell directly forward, whereas postrotation their forward motion was deviated significantly counterclockwise. The postrotation deviations were in a direction consistent with an aftereffect reflecting persistence of a compensation acquired per-rotation for voluntary swaying movements. These findings show that control and adaptation mechanisms adjusting voluntary postural sway to the demands of a new force environment also influence the automatic recovery of posture.

Podokinetic stimulation causes shifts in perception of straight ahead

Podokinetic after-rotation (PKAR) is a phenomenon in which subjects inadvertently rotate when instructed to step in place after a period of walking on a rotating treadmill. PKAR has been shown to transfer between different forms of locomotion, but has not been tested in a non-locomotor task. We conducted two experiments to assess effects of PKAR on perception of subjective straight ahead and on quiet standing posture. Twenty-one healthy young right-handed subjects pointed to what they perceived as their subjective straight ahead with a laser pointer while they were recorded by a motion capture system both before and after a training period on the rotating treadmill. Subjects performed the pointing task while standing, sitting on a chair without a back, and a chair with a back. After the training period, subjects demonstrated a significant shift in subjective straight ahead, pointing an average of 29.1 ± 10.6° off of center. The effect was direction-specific, depending on whether subjects had trained in the clockwise or counter-clockwise direction. Postures that limited subjects' ability to rotate the body in space resulted in reduction, but not elimination, of the effect. The effect was present in quiet standing and even in sitting postures where locomotion was not possible. The robust transfer of PKAR to non-locomotor tasks, and across locomotor forms as demonstrated previously, is in contrast to split-belt adaptations that show limited transfer. We propose that, unlike split-belt adaptations, podokinetic adaptations are mediated at supraspinal, spatial orientation areas that influences spinal-level circuits for locomotion.

Movement planning with probabilistic target information

We examined how subjects plan speeded reaching movements when the precise target of the movement is not known at movement onset. Before each reach, subjects were given only a probability distribution on possible target positions. Only after completing part of the movement did the actual target appear. In separate experiments we varied the location of the mode and the scale of the prior distribution for possible targets. In both cases we found that subjects made use of prior probability information when planning reaches. We also devised two tests (Composite Benefit and Row Dominance tests) to determine whether subjects' performance met necessary conditions for optimality (defined as maximizing expected gain). We could not reject the hypothesis of optimality in the experiment where we varied the mode of the prior, but departures from optimality were found in response to changes in the scale of prior distributions.

Adaptation of postural orientation to changes in surface inclination

We previously showed that standing on an inclined surface resulted in an after-effect of leaning in many healthy, blindfolded subjects when they returned to standing on a horizontal surface (Kluzik et al. in Exp Brain Res 162:474-489, 2005). The direction of leaning depended on the direction of prior surface inclination, always in a direction that preserved the relative alignment between the body and the support surface. For example, subjects leaned forward after they stood on a toes-up-inclined surface. In the present study, we investigated how the amplitude of surface inclination affected postural muscle activity, joint position, body segment orientation, and body center of mass (CoM) and foot center of pressure (CoP) locations before, during, and after subjects stood on an inclined surface. We asked whether the mechanism that underlies the lean after-effect involves regulation of local postural variables, such as the position of the ankle joint or the level of muscle activity, or whether instead, the mechanism involves regulation of global, whole-body postural variables that can only be determined by multisensory processing, such as orientation of the trunk or the body's CoM. In one experiment, we found that varying the amplitude of a toes-up surface inclination between 2.5 degrees and 10 degrees had a systematic, linear, effect on the post-incline orientation of the trunk and head, but did not systematically affect the post-incline orientation of the legs, position of the ankle joint, the level of EMG activity, or the location of the CoP. In a second experiment, we found that preventing the legs from leaning in the post-incline period did not abolish leaning of the upper body. These findings suggest that (1) the body-to-support-surface relationship is an important reference for the CNS internal representation of postural orientation which is subject to adaptive modification and (2) the adaptive mechanism underlying the post-incline after-effect of leaning acts at the level of global, whole-body postural variables.

Head control strategies during whole-body turns

Recent reports have described the motion of individual body segments during turns toward visual targets. During a whole-body turn, the head's trajectory in space is determined by both body-in-space rotation and head-on-body rotation. To inform subsequent investigations of head control strategies during turns, we provide a kinematic description of head and pelvis rotation in 20 healthy human subjects as they performed step turns toward a visible target or in the direction of a previously seen target. At the time of peak head velocity in space, the head was moving faster than the pelvis by approximately 54 degrees s(-1) when turning toward a visible target, and approximately 25 degrees s(-1) when turning in a remembered direction. Peak head velocities were slower in the absence of a visual target, but pelvis velocities were not significantly different. The pattern of relative motion between the head and pelvis followed a temporal sequence. Early in the turn, the head rotated with respect to the pelvis in the same direction as the pelvis was rotating in space. During the mid portions of the turn, en bloc rotation of the head and pelvis predominated. Later in the turn, head-in-space velocity was lower than pelvis-in-space velocity, and was thus relatively stabilized. This pattern of head movement during turns is quite similar to eye-in-head movements during large eye-head gaze shifts. This suggests that in addition to saccadic and stabilization mechanisms, a specific control strategy to move segments together should be incorporated into models of gaze reorienting behavior.

Motor control and learning in altered dynamic environments

Dynamic perturbations of reaching movements are an important technique for studying motor learning and adaptation. Adaptation to non-contacting, velocity-dependent inertial Coriolis forces generated by arm movements during passive body rotation is very rapid, and when complete the Coriolis forces are no longer sensed. Adaptation to velocity-dependent forces delivered by a robotic manipulandum takes longer and the perturbations continue to be perceived even when adaptation is complete. These differences reflect adaptive self-calibration of motor control versus learning the behavior of an external object or 'tool'. Velocity-dependent inertial Coriolis forces also arise in everyday behavior during voluntary turn and reach movements but because of anticipatory feedforward motor compensations do not affect movement accuracy despite being larger than the velocity-dependent forces typically used in experimental studies. Progress has been made in understanding: the common features that determine adaptive responses to velocity-dependent perturbations of jaw and limb movements; the transfer of adaptation to mechanical perturbations across different contact sites on a limb; and the parcellation and separate representation of the static and dynamic components of multiforce perturbations.