Acceleration threshold detection during short anterior and posterior perturbations on a translating platform

Young adults perceive small disturbances to their walking balance even when distracted

BACKGROUND

The ability to perceive disturbances to ongoing locomotion (e.g., slips and trips) may play an important role in walking balance control. However, how well young adults can perceive such disturbances is unknown.

RESEARCH QUESTION

The purpose of this study was to identify the perception threshold in young adults to subtle slip-like locomotor disturbances.

METHODS

Subjects (n = 12) walked on a split-belt treadmill performing a perturbation discrimination task at their preferred walking speed while randomly experiencing locomotor balance disturbances every 8-12 strides. Balance disturbances were imposed through a short-duration decrease in velocity of a single treadmill belt triggered at heel-strike. The treadmill belt returned to the subject's preferred walking speed during the subsequent swing phase. Locomotor disturbances were given with eight different velocity changes ranging from 0 to 0.4 m/s and were randomized and repeated 5 times. Subjects were prompted to respond when asked if they perceived each disturbance. Using a psychophysical approach, we determined the perception thresholds of slip-like locomotor disturbances (i.e., just noticeable difference). The perturbation discrimination task was repeated with subjects performing a secondary cognitive distraction (counting backward by threes).

RESULTS

Subjects perceived small locomotor disturbances during both normal walking (dominant: 0.07 ± 0.03 m/s, non-dominant: 0.08 ± 0.03 m/s) and while performing the secondary cognitive task (dominant: 0.08 ± 0.01 m/s, non-dominant: 0.09 ± 0.02 m/s). There was no significant difference between legs (p = 0.466), with the addition of the cognitive task (p = 0.08), or interaction between leg and task (p = 0.994).

SIGNIFICANCE

The ability to perceive subtle slip-like locomotor disturbances was maintained even when performing a cognitively distracting task, suggesting that young adults can perceive very small locomotor disturbances.

Enhancing sensory acuity and balance function using near-sensory biofeedback-based perturbation intervention for individuals with traumatic brain injury

BACGROUND

Interventions addressing balance dysfunction after traumatic brain injury (TBI) only target compensatory aspects and do not investigate perceptual mechanisms such as sensory acuity.

OBJECTIVE

To evaluate the efficacy of a novel intervention that integrates sensory acuity with a perturbation-based approach for improving the perception and functional balance after TBI.

METHODS

A two-group design was implemented to evaluate the effect of a novel, perturbation-based balance intervention. The intervention group (n = 5) performed the intervention with the sinusoidal (0.33, 0.5, and 1 Hz) perturbations to the base of support with amplitudes derived using our novel outcome of sensory acuity - perturbation perception threshold (PPT). The efficacy is evaluated using changes in PPT and functional outcomes (Berg Balance Scale (BBS), Timed-up and Go (TUG), 5-meter walk test (5MWT), and 10-meter walk test (10MWT)).

RESULTS

There was a significant post-intervention change in PPT for 0.33 Hz (p = 0.021). Additionally, clinically and statistically significant improvements in TUG (p = 0.03), 5MWT (p = 0.05), and 10MWT (p = 0.04) were observed.

CONCLUSIONS

This study provides preliminary efficacy of a novel, near-sensory balance intervention for individuals with TBI. The use of PPT is suggested for a comprehensive understanding and treatment of balance dysfunction. The promising results support the investigation in a larger cohort.

Lower-Limb Amputees Adjust Quiet Stance in Response to Manipulations of Plantar Sensation

Interfering with or temporarily eliminating foot-sole tactile sensations causes postural adjustments. Furthermore, individuals with impaired or missing foot-sole sensation, such as lower-limb amputees, exhibit greater postural instability than those with intact sensation. Our group has developed a method of providing tactile feedback sensations projected to the missing foot of lower-limb amputees via electrical peripheral nerve stimulation (PNS) using implanted nerve cuff electrodes. As a step toward effective implementation of the system in rehabilitation and everyday use, we compared postural adjustments made in response to tactile sensations on the missing foot elicited by our system, vibration on the intact foot-sole, and a control condition in which no additional sensory input was applied. Three transtibial amputees with at least a year of experience with tactile sensations provided by our PNS system participated in the study. Participants stood quietly with their eyes closed on their everyday prosthesis while electrically elicited, vibratory, or no additional sensory input was administered for 20 s. Early and steady-state postural adjustments were quantified by center of pressure location, path length, and average angle over the course of each trial. Electrically elicited tactile sensations and vibration both caused shifts in center of pressure location compared to the control condition. Initial (first 3 s) shifts in center of pressure location with electrically elicited or vibratory sensory inputs often differed from shifts measured over the full 20 s trial. Over the full trial, participants generally shifted toward the foot receiving additional sensory input, regardless of stimulation type. Similarities between responses to electrically elicited tactile sensations projected to the missing foot and responses to vibration in analogous regions on the intact foot suggest that the motor control system treats electrically elicited tactile inputs similarly to native tactile inputs. The ability of electrically elicited tactile inputs to cause postural adjustments suggests that these inputs are incorporated into sensorimotor control, despite arising from artificial nerve stimulation. These results are encouraging for application of neural stimulation in restoring missing sensory feedback after limb loss and suggest PNS could provide an alternate method to perturb foot-sole tactile information for investigating integration of tactile feedback with other sensory modalities.

Evaluating Sensory Acuity as a Marker of Balance Dysfunction After a Traumatic Brain Injury: A Psychophysical Approach

There is limited research on sensory acuity i.e., ability to perceive external perturbations via body-sway during standing in individuals with a traumatic brain injury (TBI). It is unclear whether sensory acuity diminishes after a TBI and if it is a contributing factor to balance dysfunction. The objective of this investigation is to first objectively quantify the sensory acuity in terms of perturbation perception threshold (PPT) and determine if it is related to functional outcomes of static and dynamic balance. Ten individuals with chronic TBI and 11 age-matched healthy controls (HC) performed PPT assessments at 0.33, 0.5, and 1 Hz horizontal perturbations to the base of support in the anterior-posterior direction, and a battery of functional assessments of static and dynamic balance and mobility [Berg balance scale (BBS), timed-up and go (TUG) and 5-m (5MWT) and 10-m walk test (10MWT)]. A psychophysical approach based on Single Interval Adjustment Matrix Protocol (SIAM), i.e., a yes-no task, was used to quantify the multi-sensory thresholds of perceived external perturbations to calculate PPT. A mixed-design analysis of variance (ANOVA) and post-hoc analyses were performed using independent and paired t-tests to evaluate within and between-group differences. Pearson correlation was computed to determine the relationship between the PPT and functional measures. The PPT values were significantly higher for the TBI group (0.33 Hz: 2.97 ± 1.0, 0.5 Hz: 2.39 ± 0.7, 1 Hz: 1.22 ± 0.4) compared to the HC group (0.33 Hz: 1.03 ± 0.6, 0.5 Hz: 0.89 ± 0.4, 1 Hz: 0.42 ± 0.2) for all three perturbation frequencies (p < 0.006 post Bonferroni correction). For the TBI group, the PPT for 1 Hz perturbations showed significant correlation with the functional measures of balance (BBS: r = −0.66, p = 0.037; TUG: r = 0.78, p = 0.008; 5MWT: r = 0.67, p = 0.034, 10MWT: r = 0.76, p = 0.012). These findings demonstrate that individuals with TBI have diminished sensory acuity during standing which may be linked to impaired balance function after TBI.

Perception of whole-body motion during balance perturbations is impaired in Parkinson's disease and is associated with balance impairment

BACKGROUND

In addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions.

RESEARCH QUESTION

We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group.

METHODS

Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the "same" or "different" direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to "just-noticeable differences" in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score.

RESULTS

20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40).

SIGNIFICANCE

Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.

Emergence of Lissajous Patterns as a Function of a Perturbation Frequency in Postural Responses to the Short Sinusoidal Translations of Varying Frequencies

The existence of in-phase and anti-phase postural responses to sinusoidal perturbations to the base of support is well known. In this study, we investigate if such coordinated postural responses exist at 'near-sway' perturbations where the perturbation amplitudes are kept within the range of normal sway lengths in healthy adults (n=10). The postural responses are analyzed via bursts of anterior-posterior (AP) 2.5 mm horizontal sinusoidal oscillations of the base of support at sequentially varying frequencies (0.25, 0.375, 0.5, 0.625, 0.75, 1 and 1.25 Hz). The parametric plots of the perturbation signal (platform position) and the response profiles (AP Center of Pressure [APCoP]) show the emergence of elliptical Lissajous patterns as the perturbation frequency is increased from 0.25 Hz to 1.25 Hz. The presence of such characteristic pattern shows the 'lock-in' behavior of APCoP with perturbation signal. These elliptical patterns become more apparent at the center frequencies (0.375 to 0.75 Hz). At the higher frequencies (1 and 1.25 Hz), the Lissajous patterns do exist but are dominated by low-frequency drift. The area and orientation of Lissajous patterns and the phase shifts between perturbation and APCoP show a strong nonlinear decreasing trend with increasing perturbation frequency for both, young (n=5) as well as mature (n=5) adults within the study group. This may suggest that such characteristic, frequency-locked, phased shifted response of healthy posture control could be a fundamental property of a healthy posture control's response to 'near-sway' sinusoidal translations in AP direction.

Directional acuity of whole-body perturbations during standing balance

The ability to perceive the direction of whole-body motion during standing may be critical to maintaining balance and preventing a fall. Our first goal was to quantify kinesthetic perception of whole-body motion by estimating directional acuity thresholds of support-surface perturbations during standing. The directional acuity threshold to lateral deviations in backward support-surface motion in healthy, young adults was quantified as 9.5±2.4° using the psychometric method (n=25 subjects). However, inherent limitations in the psychometric method, such as a large number of required trials and the predetermined stimulus set, may preclude wider use of this method in clinical populations. Our second goal was to validate an adaptive algorithm known as parameter estimation by sequential testing (PEST) as an alternative threshold estimation technique to minimize the required trial count without predetermined knowledge of the relevant stimulus space. The directional acuity threshold was estimated at 11.7±3.8° from the PEST method (n=11 of 25 subjects, psychometric threshold=10.1±3.1°) using only one-third the number of trials compared to the psychometric method. Furthermore, PEST estimates of the direction acuity threshold were highly correlated with the psychometric estimates across subjects (r=0.93) suggesting that both methods provide comparable estimates of the perceptual threshold. Computational modeling of both techniques revealed similar variance in the estimated thresholds across simulations of about 1°. Our results suggest that the PEST algorithm can be used to more quickly quantify whole-body directional acuity during standing in individuals with balance impairments.

The importance of stimulus noise analysis for self-motion studies

Motion simulators are widely employed in basic and applied research to study the neural mechanisms of perception and action during inertial stimulation. In these studies, uncontrolled simulator-introduced noise inevitably leads to a disparity between the reproduced motion and the trajectories meticulously designed by the experimenter, possibly resulting in undesired motion cues to the investigated system. Understanding actual simulator responses to different motion commands is therefore a crucial yet often underestimated step towards the interpretation of experimental results. In this work, we developed analysis methods based on signal processing techniques to quantify the noise in the actual motion, and its deterministic and stochastic components. Our methods allow comparisons between commanded and actual motion as well as between different actual motion profiles. A specific practical example from one of our studies is used to illustrate the methodologies and their relevance, but this does not detract from its general applicability. Analyses of the simulator’s inertial recordings show direction-dependent noise and nonlinearity related to the command amplitude. The Signal-to-Noise Ratio is one order of magnitude higher for the larger motion amplitudes we tested, compared to the smaller motion amplitudes. Simulator-introduced noise is found to be primarily of deterministic nature, particularly for the stronger motion intensities. The effect of simulator noise on quantification of animal/human motion sensitivity is discussed. We conclude that accurate recording and characterization of executed simulator motion are a crucial prerequisite for the investigation of uncertainty in self-motion perception.

Empirical mode decomposition/Hilbert transform analysis of postural responses to small amplitude anterior-posterior sinusoidal translations of varying frequencies

Bursts of 2.5mm horizontal sinusoidal anterior-posterior oscillations of sequentially varying frequencies (0.25 to 1.25 Hz) are applied to the base of support to study postural control. The Empirical Mode Decomposition (EMD) algorithm decomposes the Center of Pressure (CoP) data (5 young, 4 mature adults) into Intrinsic Mode Functions (IMFs). Hilbert transforms are applied to produce each IMF's time-frequency spectrum. The most dominant mode in total energy indicates a sway ramble with a frequency content below 0.1 Hz. Other modes illustrate that the stimulus frequencies produce a 'locked-in' behavior of CoP with platform position signal. The combined Hilbert Spectrum of these modes shows that this phase-lock behavior of APCoP is more apparent for 0.5, 0.625, 0.75 and 1 Hz perturbation intervals. The instantaneous energy profiles of the modes depict significant energy changes during the stimulus intervals in case of lock-in. The EMD technique provides the means to visualize the multiple oscillatory modes present in the APCoP signal with their time scale dependent on the signals's successive extrema. As a result, the extracted oscillatory modes clearly show the time instances when the subject's APCoP clearly synchronizes with the provided sinusoidal platform stimulus and when it does not.

Predicting direction detection thresholds for arbitrary translational acceleration profiles in the horizontal plane

In previous research, direction detection thresholds have been measured and successfully modeled by exposing participants to sinusoidal acceleration profiles of different durations. In this paper, we present measurements that reveal differences in thresholds depending not only on the duration of the profile, but also on the actual time course of the acceleration. The measurements are further explained by a model based on a transfer function, which is able to predict direction detection thresholds for all types of acceleration profiles. In order to quantify a participant's ability to detect the direction of motion in the horizontal plane, a four-alternative forced-choice task was implemented. Three types of acceleration profiles (sinusoidal, trapezoidal and triangular) were tested for three different durations (1.5, 2.36 and 5.86 s). To the best of our knowledge, this is the first study which varies both quantities (profile and duration) in a systematic way within a single experiment. The lowest thresholds were found for trapezoidal profiles and the highest for triangular profiles. Simulations for frequencies lower than the ones actually measured predict a change from this behavior: Sinusoidal profiles are predicted to yield the highest thresholds at low frequencies. This qualitative prediction is only possible with a model that is able to predict thresholds for different types of acceleration profiles. Our modeling approach represents an important advancement, because it allows for a more general and accurate description of perceptual thresholds for simple and complex translational motions.

Categorizing and comparing psychophysical detection strategies based on biomechanical responses to short postural perturbations

Background

A fundamental unsolved problem in psychophysical detection experiments is in discriminating guesses from the correct responses. This paper proposes a coherent solution to this problem by presenting a novel classification method that compares biomechanical and psychological responses.

Methods

Subjects (13) stood on a platform that was translated anteriorly 16 mm to find psychophysical detection thresholds through a Adaptive 2-Alternative-Forced-Choice (2AFC) task repeated over 30 separate sequential trials. Anterior-posterior center-of-pressure (APCoP) changes (i.e., the biomechanical response R_B) were analyzed to determine whether sufficient biomechanical information was available to support a subject's psychophysical selection (R_Ψ) of interval 1 or 2 as the stimulus interval. A time-series-bitmap approach was used to identify anomalies in interval 1 (a₁) and interval 2 (a₂) that were present in the resultant APCoP signal. If a₁ > a₂ then R_B = Interval 1. If a₁ < a₂, then R_B= Interval 2. If a₂ - a₁ < 0.1, R_B was set to 0 (no significant difference present in the anomaly scores of interval 1 and 2).

Results

By considering both biomechanical (R_B) and psychophysical (R_Ψ) responses, each trial run could be classified as a: 1) HIT (and True Negative), if R_B and R_Ψ both matched the stimulus interval (SI); 2) MISS, if R_B matched SI but the subject's reported response did not; 3) PSUEDO HIT, if the subject signalled the correct SI, but R_B was linked to the non-SI; 4) FALSE POSITIVE, if R_B = R_Ψ, and both associated to non-SI; and 5) GUESS, if R_B = 0, if insufficient APCoP differences existed to distinguish SI. Ensemble averaging the data for each of the above categories amplified the anomalous behavior of the APCoP response.

Conclusions

The major contributions of this novel classification scheme were to define and verify by logistic models a 'GUESS' category in these psychophysical threshold detection experiments, and to add an additional descriptor, "PSEUDO HIT". This improved classification methodology potentially could be applied to psychophysical detection experiments of other sensory modalities.

The effects of diabetes and/or peripheral neuropathy in detecting short postural perturbations in mature adults

Background

This study explored the effects of diabetes mellitus (DM) and peripheral neuropathy (PN) on the ability to detect near-threshold postural perturbations.

Methods

83 subjects participated; 32 with type II DM (25 with PN and 7 without PN), 19 with PN without DM, and 32 without DM or PN. Peak acceleration thresholds for detecting anterior platform translations of 1 mm, 4 mm, and 16 mm displacements were determined. A 2(DM) × 2(PN) factorial MANCOVA with weight as a covariate was calculated to compare acceleration detection thresholds among subjects who had DM or did not and who had PN or did not.

Results

There was a main effect for DM but not for PN. Post hoc analysis revealed that subjects with DM required higher accelerations to detect a 1 mm and 4 mm displacement.

Conclusion

Our findings suggest that PN may not be the only cause of impaired balance in people with DM. Clinicians should be aware that diabetes itself might negatively impact the postural control system.

A phase-locked loop model of the response of the postural control system to periodic platform motion

A phase-locked loop (PLL) model of the response of the postural control system to periodic platform motion is proposed. The PLL model is based on the hypothesis that quiet standing (QS) postural sway can be characterized as a weak sinusoidal oscillation corrupted with noise. Because the signal to noise ratio is quite low, the characteristics of the QS oscillator are not measured directly from the QS sway, instead they are inferred from the response of the oscillator to periodic motion of the platform. When a sinusoidal stimulus is applied, the QS oscillator changes speed as needed until its frequency matches that of the platform, thus achieving phase lock in a manner consistent with a PLL control mechanism. The PLL model is highly effective in representing the frequency, amplitude, and phase shift of the sinusoidal component of the phase-locked response over a range of platform frequencies and amplitudes. Qualitative analysis of the PLL control mechanism indicates that there is a finite range of frequencies over which phase lock is possible, and that the size of this capture range decreases with decreasing platform amplitude. The PLL model was tested experimentally using nine healthy subjects and the results reveal good agreement with a mean phase shift error of 13.7 degrees and a mean amplitude error of 0.8 mm.

Characterization of postural stability in a simulated environment of an earthquake using in-shoe plantar pressure measurement

An abled individual is believed to be capable of withstanding and overcoming the severe tremors of an earthquake as has been ascertained in a previous study. However, the event-related physiological mechanisms of human postural stability during an earthquake are subject to further investigation. Accordingly, the objective of this study is to further characterize postural stability in a simulated environment of an earthquake using a pedar-x (novel gmbh, Munich, Germany) in-shoe dynamic plantar pressure measurement system. A foot mask, dividing each of the insoles into seven plantar loading regions, was employed in this study. This paper reports preliminary results obtained from a normal adult female test subject with right side dominance and a normal foot arch. The test trial was comprised of 12 stages, ranging from quiet standing to simulated earthquake magnitude of 6.7 degrees on the Richter's scale, which is considered to be violent. The study metrics included: mean plantar pressure, foot-to-ground contact duration, insole loading area, and the position, displacement, and instantaneous velocity of the center of pressure. The study showed bilateral quantifiable changes in these metrics by foot-mask-region as a result of increasing magnitudes of simulated tremors. The subject was able to defy the overwhelming perturbations and maintain her balance and postural stability throughout the test period. The significance of this study lies in its ability to determine the threshold of falling within different subject populations in the event of an earthquake.

Postural prioritization defines the interaction between a reaction time task and postural perturbations

Concurrent demands for postural and cognitive control processes are now known to induce interference, e.g., information processing speed may decrease during postural adjustment. It is less clear whether postural control may, at least in many situations, take precedence over cognitive control ("postural prioritization"). The purpose of this study was to determine if postural dual-task effects are the result of a postural prioritization effect. Twelve young subjects (6 female; 24.1 +/- 4.1) performed a discrete choice reaction time (RT) task in combination with a platform perturbation. To assess the effect of postural prioritization on RT and center of pressure (COP) parameters, destabilizing perturbations were randomly interspersed with non-destabilizing perturbations. Furthermore, stimulus order and the time interval of the RT stimulus relative to the platform perturbation were manipulated. COP and RT data obtained in these manipulations were compared to single-task baseline data. The results suggested that, irrespective of the degree of threat to postural stability, postural task processes are prioritized. Furthermore, anticipation of a postural stimulus negatively affects RT. However, once a perturbation commences subsequent RTs are speeded. Postural reactions were unaffected by a concurrent RT task, however. The RT stimulus acted as a cue to initiate biomechanical adaptations for an upcoming perturbation.

Does Tai Chi improve plantar sensory ability? A pilot study

BACKGROUND

Aging adversely affects balance and increases the propensity to slip and fall. Loss of plantar sensation due to diabetic peripheral neuropathy and other diseases has been shown to further increase this propensity to fall. The ancient Chinese art of Tai Chi has been previously shown as a method to improve balance in healthy elderly adults.

METHODS

The aim of this study was to determine if Tai Chi intervention improved both balance and plantar sensory perception in healthy elderly adults and elderly adults with diabetes and plantar sensory loss. Elderly subjects (mean +/- SD age = 73.1 +/- 5.9 years, n = 18) were tested for plantar sensory ability and several balance metrics before Tai Chi training and again after 6 months of weekly sessions. Participants were grouped by initial sensory perception scores (as measured by a vibrometer) in order to make inferences on the effects of Tai Chi on sensory perception.

RESULTS

Plantar sensation results show all participants showed significant improvement in sensory ability with the 6 months of Tai Chi training. All groups also had a general improvement in all balance measures, with the greatest improvement seen in those subjects with large sensory losses. Hemoglobin A1C measurements also decreased as a result of the intervention.

CONCLUSION

This study demonstrates the effectiveness of Tai Chi training as a method of improving plantar sensation and balance in elderly adults and elderly adults with diabetes with a large plantar sensation loss.

Variations in Anterior-Posterior CoP Patterns in Elderly Adults Between Psychophysically Detected and Non-Detected Short Horizontal Perturbations

Using an ultra-low-vibration Sliding Linear Investigative Platform for Assessing Lower Limb Stability (SLIP-FALLS), postural responses were evaluated while subjects stood on a platform that was given a short anterior perturbation presented in one of 2 sequential test intervals for a set of 30 trials. An adaptive 2-Alternative-Forced-Choice protocol required the subject to detect platform movement. Anterior-Posterior Centers-of-Pressure (AP CoP) were compared among the detected and non-detected trials for the Healthy Elderly Adults (HEA) and Diabetic Peripheral Neuropathy (DPN) elderly adults. Results indicate that there is a significant difference between the CoP patterns for a detected and non-detected trial. Also, the range of sway is found to be higher in the case of DPN elderly adults when compared to HEA. However, the AP CoP pattern for detected trials in both HEA and DPN were the same.

Amplitude demodulation of entrained sway to analyze human postural control

This paper presents an innovative technique to study postural control. Our translating platform, the Sliding Linear Investigative Platform For Analyzing Lower Limb Stability and Simultaneous Tracking, EMG and Pressure mapping (SLIP-FALLS-STEPm), makes precise, vibration movements under controlled conditions. We look at the psychophysical thresholds to the perception of a sinusoidally induced sway. In the Sine Lock experiments described, an induced sinusoidal perturbation locks the subject's natural sway pattern at the frequency of the perturbation. The input / output system is treated as an Amplitude Shift Key (ASK) modulated signal modulating a carrier frequency (at or about a subject's natural sway frequency). The Position signal (input) and the Anterior-Posterior Center of Pressure (APCOP) signal (output) or the ankle angle are demodulated by mixing them with the pure sine wave carrier at the frequency of underlying oscillation and then low-pass filtering it to detect the amplitude envelope. These detected envelopes elucidate that the square pulse increase in the position sine wave amplitude yields a triangular increase in APCOP demodulated signal.

Effect of lateral perturbations on psychophysical acceleration detection thresholds

Background

In understanding how the human body perceives and responds to small slip-like motions, information on how one senses the slip is essential. The effect of aging and plantar sensory loss on detection of a slip can also be studied. Using psychophysical procedures, acceleration detection thresholds of small lateral whole-body perturbations were measured for healthy young adults (HYA), healthy older adults (HOA) and older adults with diabetic neuropathy (DOA). It was hypothesized that young adults would require smaller accelerations than HOA's and DOA's to detect perturbations at a given displacement.

Methods

Acceleration detection thresholds to whole-body lateral perturbations of 1, 2, 4, 8, and 16 mm were measured for HYAs, HOAs, and DOAs using psychophysical procedures including a two-alternative forced choice protocol. Based on the subject's detection of the previous trial, the acceleration magnitude of the subsequent trial was increased or decreased according to the parameter estimation by sequential testing methodology. This stair-stepping procedure allowed acceleration thresholds to be measured for each displacement.

Results

Results indicate that for lateral displacements of 1 and 2 mm, HOAs and DOAs have significantly higher acceleration detection thresholds than young adults. At displacements of 8 and 16 mm, no differences in threshold were found among groups or between the two perturbation distances. The relationship between the acceleration threshold and perturbation displacement is of particular interest. Peak acceleration thresholds of approximately 10 mm/s² were found at displacements of 2, 4, 8, and 16 mm for HYAs; at displacements of 4, 8, and 16 mm for HOAs; and at displacements of 8 and 16 mm for DOAs. Thus, 2, 4, and 8 mm appear to be critical breakpoints for HYAs, HOAs, and DOAs respectively, where the psychometric curve deviated from a negative power law relationship. These critical breakpoints likely indicate a change in the physiology of the system as it responds to the stimuli.

Conclusion

As a function of age, the displacement at which the group deviates from a negative power law relationship increases from 2 mm to 4 mm. Additionally, the displacement at which subjects with peripheral sensory deficits deviate from the negative power law relations increases to 8 mm. These increases as a function of age and peripheral sensory loss may help explain the mechanism of falls in the elderly and diabetic populations.

Factors affecting reaction times to short anterior postural disturbances

One source of falls in the elderly may be an inability to sufficiently adjust to transient postural perturbations or slips. Identifying useful predictors of fall potential, as well as factors that affect the ability of an individual to detect a movement of the standing support surface may provide insight into postural stability and methods to increase stability in elders. The effects of acceleration, displacement, neurological status, and age on movement detection reaction times were studied in 25 individuals--1 young adults, seven neurologically intact elderly adults, and six elders with (diabetic) peripheral neuropathy. Acceleration detection thresholds for anterior perturbations of 1, 4, and 16 mm of the support surface was previously determined for each subject via a two-alternative forced choice (2AFC) protocol, with longer (16 mm) moves yielding lower 2AFC thresholds (12-39 mm/s(2)) that varied by group. Using the acceleration threshold value determined, and 125% of that threshold (suprathreshold), reaction times to the start of the platform movement were determined for all three displacements. Reaction times to an additional superthreshold movement (4 mm at 100 mm/s(2)) were also measured. Lower acceleration values over longer moves required longer reaction times for motion detection. Reaction times were also influenced by peak energy imparted to the subject through the move. The higher prevalence of falls in the elderly and elderly diabetic may be due to slowing reaction times compounded by larger amounts of imparted energy needed for detection of a slipping event.

The Sway-Density Curve and the Underlying Postural Stabilization Process

The sway-density curve (SDC) is computed by counting, for each time instant, the number of consecutive samples of the statokinesigram falling inside a circle of small radius R. The authors evaluated the sensitivity of the curve to the variation of R and found that in the range 3-5 mm the sensitivity was low, indicating that SDC is a robust descriptor of posturographic patterns. In addition, they investigated the relationship between SDC and the underlying postural stabilization process by decomposing the total ankle torque into three components: a tonic component (over 69 & of the total torque), an elastic torque caused by ankle stiffness (about 19 &), and an anticipatory active torque (about 12 &). The last component, although the smallest in size, is the most critical for the overall stability of the standing posture and appears to be correlated with the SDC curve.