Spatio-temporal separation of roll and pitch balance-correcting commands in humans

Muscle synergies for multidirectional isometric force generation during maintenance of upright standing posture

Muscle synergies are defined as coordinated recruitment of groups of muscles with specific activation balances and time profiles aimed at generating task-specific motor commands. While muscle synergies in postural control have been investigated primarily in reactive balance conditions, the neuromechanical contribution of muscle synergies during voluntary control of upright standing is still unclear. In this study, muscle synergies were investigated during the generation of isometric force at the trunk during the maintenance of standing posture. Participants were asked to maintain the steady-state upright standing posture while pulling forces of different magnitudes were applied at the level at the waist in eight horizontal directions. Muscle synergies were extracted by nonnegative matrix factorization from sixteen lower limb and trunk muscles. An average of 5-6 muscle synergies were sufficient to account for a wide variety of EMG waveforms associated with changes in the magnitude and direction of pulling forces. A cluster analysis partitioned the muscle synergies of the participants into a large group of clusters according to their similarity, indicating the use of a subjective combination of muscles to generate a multidirectional force vector in standing. Furthermore, we found a participant-specific distribution in the values of cosine directional tuning parameters of synergy amplitude coefficients, suggesting the existence of individual neuromechanical strategies to stabilize the whole-body posture. Our findings provide a starting point for the development of novel diagnostic tools to assess muscle coordination in postural control and lay the foundation for potential applications of muscle synergies in rehabilitation.

Human body-sway steady-state responses to small amplitude tilts and translations of the support surface - Effects of superposition of the two stimuli

BACKGROUND

For humans, control of upright standing posture is a prerequisite for many physical activities. Experimentally, this control is often challenged by the motion of the support surface presented as tilt or translation, or some combination thereof. In particular, we have investigated subjects balancing in situations where tilt and translation stimuli were presented in isolation and compared it to a situation where such stimuli occurred simultaneously.

RESEARCH QUESTIONS

Is the human posture control system in the case of two or more superimposed external disturbances responding to these as if it were dealing with one disturbance? Or does it identify the disturbances individually and as such and respond to them specifically, as suggested in a current concept of disturbance-specific estimations and compensations?

METHODS

We had healthy human subjects controlling their balancing of upright stance on a motion platform while we presented them with different combinations of pseudorandom support surface tilt and translation stimuli alone or in superposition (with peak-to-peak amplitude of 0.5° and 1° for tilt, and 0.8 cm and 1.5 cm for translation). In one set of trials they kept their eyes closed and in a second set open. Furthermore, a simulation was performed to qualitatively evaluate the impact of sensory non-linearities and joint stiffness modulation.

RESULTS

We found that the experimental conditions 'eyes open' vs. 'eyes closed' always created significant differences (p < 0.05) between the frequency response functions. In contrast to this, with different combinations of the tilt and translation stimuli, significant differences between the responses were observed only in 5 cases over the 24 that have been tested. Significance The superposition of translation and tilt can be used to characterize the responses to both stimuli with one trial. When the amplitude of the stimuli is unbalanced (e.g. very small tilt superimposed with a larger translation) the effect of stiffness modulation can be studied.

Vestibular Function Predicts Balance and Fall Risk in Patients with Alzheimer's Disease

BACKGROUND

Patients with Alzheimer's disease (AD) are at high risk for falls. Vestibular dysfunction predicts balance impairment in healthy adults; however, its contribution to falls in patients with AD is not well known.

OBJECTIVE

The objective of this study was to assess whether vestibular function contributes to balance and fall risk in patients with AD.

METHODS

In this prospective observational study, we assessed vestibular function using measures of semicircular canal (vestibulo-ocular reflex (VOR) gain) and saccular function (cervical vestibular-evoked myogenic (cVEMP) response), and we assessed balance function using the Berg Balance Scale and quantitative posturography. We evaluated falls incidence for a mean 1-year follow-up period (range 3-21 months) in 48 patients with mild-moderate AD.

RESULTS

Relative to matched controls, AD patients exhibited increased medio-lateral (ML) sway in eyes-open (0.89 cm versus 0.69 cm; p = 0.033) and eyes-closed (0.86 cm versus 0.65 cm; p = 0.042) conditions. Among AD patients, better semicircular canal function was associated with lower ML sway and antero-posterior (AP) sway in the eyes-closed condition (β= -2.42, 95% CI (-3.89, -0.95), p = 0.002; β= -2.38, 95% CI (-4.43, -0.32), p = 0.025, respectively). Additionally, better saccular function was associated with lower sway velocity (β= -0.18, 95% CI (-0.28, -0.08); p = 0.001). Finally, we observed that better semicircular canal function was significantly associated with lower likelihood of falls when adjusted for age, sex, and MMSE score (HR = 0.65; p = 0.009).

CONCLUSION

These results support the vestibular system as an important contributor to balance and fall risk in AD patients and suggest a role for vestibular therapy.

Balance Adaptation While Standing on a Compliant Base Depends on the Current Sensory Condition in Healthy Young Adults

Background

Several investigations have addressed the process of balance adaptation to external perturbations. The adaptation during unperturbed stance has received little attention. Further, whether the current sensory conditions affect the adaptation rate has not been established. We have addressed the role of vision and haptic feedback on adaptation while standing on foam.

Methods

In 22 young subjects, the analysis of geometric (path length and sway area) and spectral variables (median frequency and mean level of both total spectrum and selected frequency windows) of the oscillation of the centre of feet pressure (CoP) identified the effects of vision, light-touch (LT) or both in the anteroposterior (AP) and mediolateral (ML) direction over 8 consecutive 90 s standing trials.

Results

Adaptation was obvious without vision (eyes closed; EC) and tenuous with vision (eyes open; EO). With trial repetition, path length and median frequency diminished with EC (p < 0.001) while sway area and mean level of the spectrum increased (p < 0.001). The low- and high-frequency range of the spectrum increased and decreased in AP and ML directions, respectively. Touch compared to no-touch enhanced the rate of increase of the low-frequency power (p < 0.05). Spectral differences in distinct sensory conditions persisted after adaptation.

Conclusion

Balance adaptation occurs during standing on foam. Adaptation leads to a progressive increase in the amplitude of the lowest frequencies of the spectrum and a concurrent decrease in the high-frequency range. Within this common behaviour, touch adds to its stabilising action a modest effect on the adaptation rate. Stabilisation is improved by favouring slow oscillations at the expense of sway minimisation. These findings are preliminary to investigations of balance problems in persons with sensory deficits, ageing, and peripheral or central nervous lesion.

Improvement of Asymmetric Vestibulo-Ocular Reflex Responses Following Onset of Vestibular Neuritis Is Similar Across Canal Planes

Background: We examined whether, after onset of acute unilateral vestibular neuritis (aUVN), initial disease effects, subsequent peripheral recovery and central compensation cause similar changes in vestibular ocular reflex (VOR) gains in all 3 semi-circular canal planes. Methods: 20 patients, mean age 56.5 years, with pathological lateral canal video head impulse test (vHIT) VOR gains due to aUVN, were subsequently examined with vHIT in all 3 canal planes on average 4.3 and 36.7 days ("5 weeks") after aUVN onset. Results: Lateral and anterior deficit side (DS) average gains equaled 0.41 at aUVN onset. Non-deficit, normal, side (NS) gains were 0.88 and 0.81, respectively. Mean posterior DS gain was similar at onset, 0.43, provided only gains lower than 0.6 (lower limit of healthy controls) were considered. NS posterior mean gain at onset (0.68) was less (p ≤ 0.0006) than lateral and anterior NS gains. After 5 weeks, DS lateral, anterior and posterior canal gains increased (p ≤ 0.05), on average, to 0.65, 0.59, and 0.58, respectively. NS gains increased to 0.91, 0.87, and 0.76 (p = 0.007), respectively. At 5 weeks deficit-lateral/normal-lateral canal plane gain asymmetries were significantly (p < 0.0008) reduced from 36.9 to 19.4%, deficit-anterior/normal-posterior asymmetry decreased from 28.6 to 18.1%, while deficit-posterior/normal-anterior asymmetry changed from 29.7 to 21.4%, all to circa 20%. Roll plane asymmetries decreased slightly over 5 weeks (28.6-18.1%) but pitch plane asymmetries remained significantly less (p = 0.001), not different from 0% regardless of initial DS posterior canal vHIT gain. Yaw plane asymmetry changes are identical to those of the lateral canals (36.7-19.4%). Conclusions: These results indicate that, at onset, aUVN of the superior vestibular nerve has a similar effect on lateral and anterior deficit DS VOR gains, and on posterior DS canal VOR gains if the inferior nerve was also affected at onset. The significant improvements to equal 5 week levels of DS gains and slightly greater posterior NS gain improvements, compared to lateral and anterior NS gains, yielding a common canal plane gain asymmetry of 20% at 5 weeks, suggest similar neural compensation mechanisms were active along VOR pathways. Unexpectantly, canal plane improvement was not replicated in pitch plane asymmetries.

Biarticular muscles are most responsive to upper-body pitch perturbations in human standing

Balancing the upper body is pivotal for upright and efficient gait. While models have identified potentially useful characteristics of biarticular thigh muscles for postural control of the upper body, experimental evidence for their specific role is lacking. Based on theoretical findings, we hypothesised that biarticular muscle activity would increase strongly in response to upper-body perturbations. To test this hypothesis, we used a novel Angular Momentum Perturbator (AMP) that, in contrast to existing methods, perturbs the upper-body posture with only minimal effect on Centre of Mass (CoM) excursions. The impulse-like AMP torques applied to the trunk of subjects resulted in upper-body pitch deflections of up to 17° with only small CoM excursions below 2 cm. Biarticular thigh muscles (biceps femoris long head and rectus femoris) showed the strongest increase in muscular activity (mid- and long-latency reflexes, starting 100 ms after perturbation onset) of all eight measured leg muscles which highlights the importance of biarticular muscles for restoring upper-body balance. These insights could be used for improving technological aids like rehabilitation or assistive devices, and the effectiveness of physical training for fall prevention e.g. for elderly people.

Haptic Cues for Balance: Use of a Cane Provides Immediate Body Stabilization

Haptic cues are important for balance. Knowledge of the temporal features of their effect may be crucial for the design of neural prostheses. Touching a stable surface with a fingertip reduces body sway in standing subjects eyes closed (EC), and removal of haptic cue reinstates a large sway pattern. Changes in sway occur rapidly on changing haptic conditions. Here, we describe the effects and time-course of stabilization produced by a haptic cue derived from a walking cane. We intended to confirm that cane use reduces body sway, to evaluate the effect of vision on stabilization by a cane, and to estimate the delay of the changes in body sway after addition and withdrawal of haptic input. Seventeen healthy young subjects stood in tandem position on a force platform, with eyes closed or open (EO). They gently lowered the cane onto and lifted it from a second force platform. Sixty trials per direction of haptic shift (Touch → NoTouch, T-NT; NoTouch → Touch, NT-T) and visual condition (EC-EO) were acquired. Traces of Center of foot Pressure (CoP) and the force exerted by cane were filtered, rectified, and averaged. The position in space of a reflective marker positioned on the cane tip was also acquired by an optoelectronic device. Cross-correlation (CC) analysis was performed between traces of cane tip and CoP displacement. Latencies of changes in CoP oscillation in the frontal plane EC following the T-NT and NT-T haptic shift were statistically estimated. The CoP oscillations were larger in EC than EO under both T and NT (p < 0.001) and larger during NT than T conditions (p < 0.001). Haptic-induced effect under EC (Romberg quotient NT/T ~ 1.2) was less effective than that of vision under NT condition (EC/EO ~ 1.5) (p < 0.001). With EO cane had little effect. Cane displacement lagged CoP displacement under both EC and EO. Latencies to changes in CoP oscillations were longer after addition (NT-T, about 1.6 s) than withdrawal (T-NT, about 0.9 s) of haptic input (p < 0.001). These latencies were similar to those occurring on fingertip touch, as previously shown. Overall, data speak in favor of substantial equivalence of the haptic information derived from both “direct” fingertip contact and “indirect” contact with the floor mediated by the cane. Cane, finger and visual inputs would be similarly integrated in the same neural centers for balance control. Haptic input from a walking aid and its processing time should be considered when designing prostheses for locomotion.

Action Direction of Muscle Synergies in Voluntary Multi-Directional Postural Control

A muscle synergy is a coordinative structure of muscles that has been proposed as a strategy to reduce the number of variables that the central nervous system (CNS) has to address in motor tasks. In this article, the mechanical contribution of muscle synergies and coordinative structures of muscles in voluntary multi-directional postural control were investigated. The task for healthy, young subjects was to shift and align their center of pressure (COP) to targets dispersed in 12 different directions in the horizontal plane by leaning their bodies for 10 s. Electromyograms (EMGs) of 18 muscles and COPs were recorded in the experiment. Muscle synergies were extracted using non-negative matrix factorization (NMF), and the structure of coordinative modules to keep the posture leaning toward various directions was disclosed. Then the directional properties, such as the mechanical role (i.e., action directions, we use ADs as abbreviation below), of muscle synergies and muscles were estimated using an electromyogram-weighted averaging (EWA) method, which is based on a cross-correlation between the fluctuations in the activation of muscle synergies and the COP. The results revealed that the ADs of muscle synergies were almost uniformly distributed in the task space in most of the subjects, which indicates that mechanical characteristics reduce the redundancy in postural control. In terms of the composition of muscle synergies and the ADs of individual muscles, we confirmed that muscle synergies in multi-directional postural control comprised a combination of several muscles, including various ADs, that generate torque at different joints.

The Effects of Temporal and Spatial Predictions on Stretch Reflexes of Ankle Flexor and Extensor Muscles While Standing

The purpose of the present study was to investigate how stretch reflex (SR) responses in the ankle extensor (soleus: SOL) and flexor (tibialis anterior: TA) muscles would be modulated with temporal and/or spatial predictions of external perturbations and whether their effects are specific to the standing posture. SR responses in the SOL/TA were elicited by imposing quick ankle toes-up/toes-down rotations while standing upright and in the supine position. We designed four experimental conditions based on pre-information about perturbations: no information (No Cue), the timing of the perturbation onset (TIM), the direction of the perturbation (DIR), and both the timing and direction of the perturbation (TIM/DIR). Each condition was separated and its order was counterbalanced. In the SR of TA evoked by toes-down rotation, integrated electromyography activities of the late component were significantly reduced in the TIM and TIM/DIR conditions as compared with those in the No Cue and DIR conditions. The occurrence rate of late SR components that reflects how often the reflex response was observed was also lower in the TIM and TIM/DIR conditions as compared with that in the No Cue and DIR conditions. On the other hand, no significant changes were seen among the four conditions in the early SR component in the TA and both SR components in the SOL. The same results in the occurrence rate were found in the supine position. The present results suggest (1) only temporal predictions have a remarkable effect on the SR excitability of the TA, and (2) this effect is independent of posture.

Upper body balance control strategy during continuous 3D postural perturbation in young adults

We explored how changes in vision and perturbation frequency impacted upright postural control in healthy adults exposed to continuous multiaxial support-surface perturbation. Ten subjects were asked to maintain equilibrium in standing stance with eyes open (EO) and eyes closed (EC) during sinusoidal 3D rotations at 0.25 (L) and 0.50 Hz (H). We measured upper-body kinematics--head, trunk, and pelvis--and analyzed differences in horizontal displacements and roll, pitch, and yaw sways. The presence of vision significantly decreased upper-body displacements in the horizontal plane, especially at the head level, while in EC the head was the most unstable segment. H trials produced a greater segment stabilization compared to L ones in EO and EC. Analysis of sways showed that in EO participants stabilized their posture by reducing the variability of trunk angles; in H trials a sway decrease for the examined segments was observed in the yaw plane and, for the pelvis only, in the pitch plane. Our results suggest that, during continuous multiaxial perturbations, visual information induced: (i) in L condition, a continuous reconfiguration of multi-body-segments orientation to follow the perturbation; (ii) in H condition, a compensation for the ongoing perturbation. These findings were not confirmed in EC where the same strategy--that is, the use of the pelvis as a reference frame for the body balance was adopted both in L and H.

Postural stabilization during bilateral and unilateral vibration of ankle muscles in the sagittal and frontal planes

BACKGROUND

The purpose was to investigate the postural consequences of proprioceptive perturbation of the Triceps Surae and Peroneus Longus muscles. These muscles are known to control posture respectively in the sagittal and frontal planes during standing.

METHODS

Standard parameters and the time course of center of pressure (CoP) displacements were recorded in 21 young adults, instructed to maintain their balance during tendon vibration. Following 4 s of baseline recording, three types of vibration (80 Hz) were applied for 20 s each on the Peroneus or Achilles tendons, either unilaterally or bilaterally (with eyes shut). The recording continued for a further 24 s after the end of the vibration during the re-stabilization phase. To evaluate the time course of the CoP displacement, each phase of the trial was divided into periods of 4 seconds. Differences between the type of tendon vibration, phases and periods were analyzed using ANOVA.

RESULTS

During all tendon vibrations, the speed of the CoP increased and a posterior displacement occurred. These changes were greater during Achilles than during Peroneus vibration for each type of vibration and also during bilateral compared with unilateral vibration. All maximal posterior positions occurred at a similar instant (between 12.7 and 14 s of vibration). Only unilateral Achilles vibration led to a significant medio-lateral displacement compared to the initial state.

CONCLUSIONS

The effect of the proprioceptive perturbation seems to be influenced by the position of the vibrated muscle according to the planes of the musculoskeletal postural organization. The amplitude of the destabilization may be related to the importance of the muscle for postural control. The medial CoP displacement which occurred during unilateral Achilles vibration is not a general reaction to a single-limb perturbation. Proprioceptive input from the non-perturbed leg was not sufficient for the antero-posterior displacement to be avoided; however, it helped to gain stability over time. The non-perturbed limb clearly plays an important role in the restoration of the postural referential, both during and immediately following the end of the vibration. The results demonstrated that at least 16 s of vibration are necessary to induce most postural effects in young adults.

Sensorimotor feedback based on task-relevant error robustly predicts temporal recruitment and multidirectional tuning of muscle synergies

We hypothesized that motor outputs are hierarchically organized such that descending temporal commands based on desired task-level goals flexibly recruit muscle synergies that specify the spatial patterns of muscle coordination that allow the task to be achieved. According to this hypothesis, it should be possible to predict the patterns of muscle synergy recruitment based on task-level goals. We demonstrated that the temporal recruitment of muscle synergies during standing balance control was robustly predicted across multiple perturbation directions based on delayed sensorimotor feedback of center of mass (CoM) kinematics (displacement, velocity, and acceleration). The modulation of a muscle synergy's recruitment amplitude across perturbation directions was predicted by the projection of CoM kinematic variables along the preferred tuning direction(s), generating cosine tuning functions. Moreover, these findings were robust in biphasic perturbations that initially imposed a perturbation in the sagittal plane and then, before sagittal balance was recovered, perturbed the body in multiple directions. Therefore, biphasic perturbations caused the initial state of the CoM to differ from the desired state, and muscle synergy recruitment was predicted based on the error between the actual and desired upright state of the CoM. These results demonstrate that that temporal motor commands to muscle synergies reflect task-relevant error as opposed to sensory inflow. The proposed hierarchical framework may represent a common principle of motor control across motor tasks and levels of the nervous system, allowing motor intentions to be transformed into motor actions.

Movement patterns underlying first trial responses in human balance corrections

BACKGROUND

We investigated whether the "first trial effect" (FTE) in responses to support surface tilt has directional characteristics, or is simply due to a startle-like response. The FTE is the difference between the first (unpractised) trial response (FTR) and subsequent responses.

METHODS

Each group of 10 young adults received a series of identical support surface tilts (7.5°, 60°/s) in one of five leftward tilt directions or pure backward or forward. These were followed by randomly selected tilts in at least eight equally spaced directions. Only in-place responses were possible as the feet were strapped to the support surface. Body kinematics were collected and EMG activity was recorded from several trunk, leg and arm muscles.

RESULTS

The centre of mass (CoM) vector displacement showed a FTE in all tilt directions. It was equally large for all directions of backward tilt but smaller for forward and lateral tilts. A similar effect was noted for the CoM anterior-posterior FTE. FTRs of lateral CoM movements were small for all tilt directions except in the backward left direction. A constant amplitude trunk flexion FTE was observed in all tilt directions, and pelvis backward motion for backward tilts, preceded by a FTE in the abdominal muscles for forward (and lateral) tilts and in the soleus for backward (and lateral) tilts. Hip flexion FTEs were largest in backward left direction and preceded by increased gluteus medius and deltoid FTR activity. FTRs in sternocleidomastoïdeus muscles, generally associated with startle activity, were largest in lateral and forward tilt directions.

CONCLUSIONS

FTRs appear to consist of either a forward, backward or lateral movement strategy each imposed on an adapted response strategy. Only the lateral response shows a strong directional sensitivity. We hypothesise that FTR amplitudes result from a failure of the CNS to weight properly the stimulus metrics present in lower leg proprioceptive and vestibular inputs.

Recovery of vestibular ocular reflex function and balance control after a unilateral peripheral vestibular deficit

This review describes the effect of unilateral peripheral vestibular deficit (UPVD) on balance control for stance and gait tests. Because a UPVD is normally defined based on vestibular ocular reflex (VOR) tests, we compared recovery observed in balance control with patterns of recovery in VOR function. Two general types of UPVD are considered; acute vestibular neuritis (AVN) and vestibular neurectomy. The latter was subdivided into vestibular loss after cerebellar pontine angle tumor surgery during which a vestibular neurectomy was performed, and vestibular loss following neurectomy to eliminate disabling Ménière's disease. To measure balance control, body-worn gyroscopes, mounted near the body's center of mass (CoM), were used. Measurement variables were the pitch (anterior-posterior) and roll (lateral) sway angles and angular velocities of the lower trunk/pelvis. Both patient groups showed balance deficits during stance tasks on foam, especially with eyes closed when stable balance control is normally highly dependent on vestibular inputs. Deficits during gait were also present and were more profound for complex gait tasks such as tandem gait than simple gait tasks. Major differences emerged between the groups concerning the severity of the deficit and its recovery. Generally, the effects of acute neuritis on balance control were more severe but recovered rapidly. Deficits due to vestibular neurectomy were less severe, but longer lasting. These results mostly paralleled recovery of deficits in VOR function. However, questions need to be raised about the effect on balance control of the two modes of neural plasticity occurring in the vestibular system following vestibular loss due to neuritis: one mode being the limited central compensation for the loss, and the second mode being some restoration of peripheral vestibular function. Future work will need to correlate deficits in balance control during stance and gait more exactly with VOR deficits and carefully consider the differences between insufficient central compensation compared to inadequate peripheral restoration of function.

Organization of physiological tremors and coordination solutions to postural pointing on an uneven stance surface

The study investigated the destabilization effect on multi-segment physiological tremors and coordinative control for a postural-suprapostural task under different stance conditions. Twenty volunteers executed postural pointing from a level surface and a seesaw balance board; meanwhile, physiological tremors of the whole postural system and fluctuation movements of fingertip/stance surface were recorded. In reference to level stance, seesaw stance led to much fewer tremor increments of the upper limb and less fluctuation movement of the fingertip than tremor increment of the lower limb and rolling movement of the stance surface. Tremor coupling between the adjacent segments organized differentially with stance surface. In reference to level stance, seesaw stance reinforced tremor coupling of the upper limb but enfeebled the coupling in the arm-lumbar and calf-foot complexes. Stance-related differences in physiological tremors could be explained by characteristic changes in the primary and secondary principal components (PC1 and PC2), with relatively high communality with segment tremors of the lower and upper limbs, respectively. Seesaw stance introduced a prominent 4-8Hz spectral peak in PC1 and potentiated 1-4Hz and 8-12Hz spectral peaks of PC2. Structural reorganization of physiological tremors with stance configuration suggests that seesaw stance involves distinct suprapostural and postural synergies for regulating degree of freedom in joint space.

Compensation following bilateral vestibular damage

Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

Postural control strategies related to anticipatory perturbation and quick perturbation in adolescent idiopathic scoliosis

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To investigate the automatic balance correction related to anticipatory perturbation (AP) and quick backward perturbation in adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

Most previous studies on AIS patients focused on posture sway and lacked analysis of muscle activated patterns in dynamic standing control.

METHODS

Thirty-two AIS patients and 23 age-matched normal subjects received perturbation balance tests on an unstable platform. The tilting angle of the platform and the muscle activity of the bilateral lumbar multifidi, gluteus medii, and gastrocnemii muscles were recorded. Electromyographic (EMG) amplitude, onset latencies, and duration were calculated with software accompanied with machine.

RESULTS

The AIS group had less posture tilting but higher muscle activities than normal subjects under both perturbation conditions (P < 0.05). Under the AP test, AIS showed earlier onset and prolonged activation of left multifidus and right gastrocnemius compared with normal subjects (P < 0.05). The latency of the multifidus on the lumbar convex side occurred earlier than on the concave side. However, the asymmetric onset timing of the gastrocnemius was the opposite of the multifidi in the AIS group (P < 0.05). In contrast to the AP condition, bilateral leg and trunk muscles activated at similar latencies and durations in the AIS group (P < 0.05). Under the quick backward perturbation test, the control group had longer active duration of right multifidus and bilateral gastrocnemii than AIS to cope with larger platform tilting. In addition, asymmetric onset of gluteus medii and duration of multifidi was observed in the control group (P < 0.05).

CONCLUSION

There were significant differences in posture control patterns between AIS and normal subjects. AIS subjects have asymmetric habitual muscle activities for AP, whereas when coping with sudden balance threats, they react with synchronized recruitment of bilateral postural muscles.

Tuning of human vestibulospinal reflexes by leg rotation

Changing the foot position modifies the mechanical action exerted by the ankle extensor and flexor muscles over the body. We verified, in two groups of healthy subjects standing with the heels touching or apart, whether a 90° external rotation of the right leg and foot also changes the pattern of vestibulospinal reflexes elicited by electrical stimulation of the labyrinth. With the head oriented forward, leg rotation did not modify the labyrinthine-driven displacements of the center of pressure (CoP). When the head was rotated in the horizontal plane, either to the right or to the left, the CoP displacement increased along the y axis in all subjects. Changes in the x component in most instances appropriate to preserve unmodified the direction of body sway elicited by the stimulus were observed. Right leg rotation increased the basal EMG activity of ankle extensors and flexors on the left side, while the right side activity was unaffected. The EMG responses to labyrinthine stimulation were modified only on the left side, in a way appropriate to correct the effects of the altered torque pattern exerted on the body by right leg muscles. It appears, therefore, that somatosensory signals related to leg rotation and/or copy of the corresponding voluntary motor commands modify the pattern of vestibulospinal reflexes and maintain the postural response appropriate to counteract a body sway in the direction inferred by labyrinthine signals.

Effect of canal plugging on quadrupedal locomotion in monkey

The vestibular system plays an important role in controling gait, but where in the labyrinths relevant activity arises is largely unknown. After the semicircular canals are plugged, low frequency (0.01-2 Hz) components of the angular vestibulo-ocular reflex (aVOR) and angular vestibulo-collic reflex (aVCR) are lost, but high frequency (3-20 Hz) components remain. We determined how loss of low frequency canal afference affects limb and head movements during quadrupedal locomotion. Head, body, and limb movements were recorded in three dimensions (3-D) in a cynomolgus monkey with a motion detection system, while the animal walked on a treadmill. All six canals were plugged, reducing the canal time constants from approximately 4.0 sec to approximately 0.07 sec. Major changes in the control of the limbs occurred after surgery. Fore and hind limbs were held farther from the body, producing a broad-based gait. Swing-phase trajectories were inaccurate, and control of medial-lateral limb movement was erratic. These changes in gait were present immediately after surgery, as well as 15 months later, when the animal had essentially recovered. Thus, control of the limbs in the horizontal plane was defective after loss of the low-frequency semicircular canal input and never recovered. Cycle-averaged pitch and roll head rotations, and 3-D head translations were also significantly larger and more erratic after than before surgery. Head rotations in yaw could not be quantified due to intrusion of voluntary head turns. These findings indicate that the semicircular canals provide critical low frequency information to maximize the accuracy of stepping and stabilize the head during normal quadrupedal locomotion.

Control of roll and pitch motion during multi-directional balance perturbations

Does the central nervous system (CNS) independently control roll and pitch movements of the human body during balance corrections? To help provide an answer to this question, we perturbed the balance of 16 young healthy subjects using multi-directional rotations of the support surface. All rotations had pitch and roll components, for which either the roll (DR) or the pitch (DP) component were delayed by 150 ms or not at all (ND). The outcome measures were the biomechanical responses of the body and surface EMG activity of several muscles. Across all perturbation directions, DR caused equally delayed shifts (150 ms) in peak lateral centre of mass (COM) velocity. Across directions, DP did not cause equally delayed shifts in anterior-posterior COM velocity. After 300 ms however, the vector direction of COM velocity was similar to the ND directions. Trunk, arm and knee joint rotations followed this roll compared to pitch pattern, but were different from ND rotation synergies after 300 ms, suggesting an intersegmental compensation for the delay effects. Balance correcting responses of muscles demonstrated both roll and pitch directed components regardless of axial alignment. We categorised muscles into three groups: pitch oriented, roll oriented and mixed based on their responses to DR and DP. Lower leg muscles were pitch oriented, trunk muscles were roll oriented, and knee and arm muscles were mixed. The results of this study suggest that roll, but not pitch components, of balance correcting movement strategies and muscle synergies are separately programmed by the CNS. Reliance on differentially activated arm and knee muscles to correct roll perturbations reveals a dependence of the pitch response on that of roll, possibly due to biomechanical constraints, and accounts for the failure of DP to be transmitted equally in time across all limbs segments. Thus it appears the CNS preferentially programs the roll response of the body and then adjusts the pitch response accordingly.

Responses to multi-directional surface translations involve redistribution of proximal versus distal strategies to maintain upright posture

Evaluation of postural control in multiple planes is necessary to determine the movement strategies used to respond to unexpected perturbations. The present study quantified net joint torques of the lower limbs and trunk in the sagittal and frontal planes following multi-directional surface translations. Twenty-one healthy subjects stood with feet on separate force plates mounted on a moveable platform, translated unexpectedly in one of 12 directions. Peak net torque magnitudes and latencies following perturbation onset were determined as were the relative contributions of each joint to total torque production. Magnitude of net torque generated by each leg varied by perturbation direction, with the largest individual joint magnitude elicited in directions of limb loading. Relative contributions of individual joint torques to the total response were dependent upon perturbation direction. Results suggest that a redistribution of the relative contributions of hip/trunk versus ankle strategies occurs dependent on perturbation direction, with a significant contribution by the knee joint in response to forward perturbations. Direction-specific redistribution of proximal versus distal strategies appears to depend upon the biomechanical constraints imposed by a given perturbation direction. Thus, it appears that sagittal and frontal plane posture-righting responses may not be uniquely controlled, and may instead be governed similarly, with modulation of relative torque contributions among joints when necessary, given direction-specific anatomical constraints.

Muscle Synergies Characterizing Human Postural Responses

Postural control is a natural behavior that requires the spatial and temporal coordination of multiple muscles. Complex muscle activation patterns characterizing postural responses suggest the need for independent muscle control. However, our previous work shows that postural responses in cats can be robustly reproduced by the activation of a few muscle synergies. We now investigate whether a similar neural strategy is used for human postural control. We hypothesized that a few muscle synergies could account for the intertrial variability in automatic postural responses from different perturbation directions, as well as different postural strategies. Postural responses to multidirectional support-surface translations in 16 muscles of the lower back and leg were analyzed in nine healthy subjects. Six or fewer muscle synergies were required to reproduce the postural responses of each subject. The composition and temporal activation of several muscle synergies identified across all subjects were consistent with the previously identified “ankle” and “hip” strategies in human postural responses. Moreover, intertrial variability in muscle activation patterns was successfully reproduced by modulating the activity of the various muscle synergies. This suggests that trial-to-trial variations in the activation of individual muscles are correlated and, moreover, represent variations in the amplitude of descending neural commands that activate individual muscle synergies. Finally, composition and temporal activation of most of the muscle synergies were similar across subjects. These results suggest that muscle synergies represent a general neural strategy underlying muscle coordination in postural tasks.

Incorporating voluntary knee flexion into nonanticipatory balance corrections

Knee movements play a critical role in most balance corrections. Loss of knee flexibility may cause postural instability. Conversely, trained voluntary knee flexions executed during balance corrections might help to overcome balance deficits. We examined whether bilateral knee flexion could be added to automatic balance corrections generated by sudden balance perturbations. We investigated how this could be achieved and whether it improved or worsened balance control. Twenty-four healthy subjects participated in three different test conditions, in which they had to flex their knees following an auditory cue (VOLUNTARY condition), had to restore their balance in response to multidirectional rotations of a support surface (REACTIVE condition), or the combination of these two (COMBINED condition). A new variable set (PREDICTED), calculated as the mathematical sum of VOLUNTARY and REACTIVE, was compared with the COMBINED variable set. COMBINED responses following forward rotations were close to PREDICTED, or greater, suggesting adequate integration of knee flexion into the automatic balance reactions. For backward rotations, the COMBINED condition resulted in several near-falls, and this was generally associated with smaller knee flexion and smaller EMG responses. Subjects compensated by using greater trunk flexion and arm movements. Activity in several muscles displayed earlier onsets for the COMBINED condition following backward rotations. We conclude that healthy adults can incorporate voluntary knee flexion into their automatic balance corrections and that this depends on the direction of the postural perturbation. These findings highlight the flexibility of the human balance repertoire and underscore both the advantages and limitations of using trained voluntary movements to aid balance corrections in man.

Differences in coding provided by proprioceptive and vestibular sensory signals may contribute to lateral instability in vestibular loss subjects

One of the signatures of balance deficits observed in vestibular loss subjects is the greater instability in the roll compared to pitch planes. Directional differences in the timing and strengths of vestibular and proprioceptive sensory signals between roll and pitch may lead to a greater miscalculation of roll than pitch motion of the body in space when vestibular input is absent. For this reason, we compared the timing and amplitude of vestibular information, (observable in stimulus-induced head accelerations when subjects are tilted in different directions), with that of proprioceptive information caused by stimulus induced rotations of ankle and hip joints [observable as short latency (SL) stretch responses in leg and trunk muscle EMG activity]. We attempted to link the possible mode of sensory interaction with the deficits in balance control. Six subjects with bilaterally absent vestibular function and 12 age-matched controls were perturbed, while standing, in 8 directions of pitch and roll support surface rotation in random order. Body segment movements were recorded with a motion analysis system, head accelerations with accelerometers, and muscle activity with surface EMG. Information on stimulus pitch motion was available sequentially. Pitch movements of the support surface were best coded in amplitude by ankle rotation velocity, and by head vertical linear acceleration, which started at 13 ms after the onset of ankle rotation. EMG SL reflex responses in soleus with onsets at 46 ms provided a distal proprioceptive correlate to the pitch motion. Roll information on the stimulus was available simultaneously. Hip adduction and lumbo-sacral angular velocity were represented neurally as directionally specific short latency stretch and unloading reflexes in the bilateral gluteus medius muscles and paraspinal muscles with onsets at 28 ms. Roll angular accelerations of the head coded roll amplitude and direction at the same time (31 ms). Significant differences in amplitude coding between vestibular loss subjects and controls were only observed as a weaker coding between stimulus motion and head roll and head lateral linear accelerations. The absence of vestibular inputs in vestibular loss subjects led to characteristic larger trunk in motion in roll in the direction of tilt compared to pitch with respect to controls. This was preceded by less uphill flexion and no downhill extension of the legs in vestibular loss subjects. Downhill arm abduction responses were also greater. These results suggest that in man vestibular inputs provide critical information necessary for the appropriate modulation of roll balance-correcting responses in the form of stabilising knee and arm movements. The simultaneous arrival of roll sensory information in controls may indicate that proprioceptive and vestibular signals can only be interpreted correctly when both are present. Thus, roll proprioceptive information may be interpreted inaccurately in vestibular loss subjects, leading to an incorrect perception of body tilt and insufficient uphill knee flexion, especially as cervico-colic signals appear less reliable in these subjects as an alternative sensory input.

Muscle proprioceptive feedback and spinal networks

This review revolves primarily around segmental feedback systems established by muscle spindle and Golgi tendon organ afferents, as well as spinal recurrent inhibition via Renshaw cells. These networks are considered as to their potential contributions to the following functions: (i) generation of anti-gravity thrust during quiet upright stance and the stance phase of locomotion; (ii) timing of locomotor phases; (iii) linearization and correction for muscle nonlinearities; (iv) compensation for muscle lever-arm variations; (v) stabilization of inherently unstable systems; (vi) compensation for muscle fatigue; (vii) synergy formation; (viii) selection of appropriate responses to perturbations; (ix) correction for intersegmental interaction forces; (x) sensory-motor transformations; (xi) plasticity and motor learning. The scope will at times extend beyond the narrow confines of spinal circuits in order to integrate them into wider contexts and concepts.

Parallels in control of voluntary and perturbation-evoked reach-to-grasp movements: EMG and kinematics

To determine the potential differences in control underlying compensatory and voluntary reach-to-grasp movements the current study compared the kinematic and electromyographic profiles associated with upper limb movement. Postural perturbations were delivered to evoke compensatory reach-to-grasp in ten healthy young adult volunteers while seated on a chair that tilted as an inverted pendulum in the frontal plane. Participants reached to grasp a laterally positioned stable handhold and pulled (or pushed) to return the chair to vertical. The distinguishing characteristic between the two behaviors was the onset latency and speed of movement. Consistent with compensatory balance reactions, the perturbation-evoked reach response was initiated very rapidly (137 vs. 239 ms for voluntary). As well the movement time was shorter, and peak velocity was greater for PERT movements. In spite of the profound differences in timing, the sequence of muscle activity onsets and the order of specific kinematic events were not different between maximum velocity voluntary (VOL) and perturbation-evoked (PERT) reach-to-grasp movements. Peak velocity and grasp aperture occurred prior to hand contact with the target for PERT and VOL movements, and wrist trajectory was influenced by the direction of perturbation relative to the target. To achieve such target specific control for responses initiated within 100 ms of the perturbation, and when characteristics of body movement were unpredictable, the perturbation-evoked movements would need to incorporate sensory cues associated with body movement relative to the target into the earliest aspects of the movement. This suggests reliance on an internal spatial map constructed prior to the onset of perturbation. Parallels in electromyographic and kinematic profiles between compensatory and voluntary reach-to-grasp movements, in spite of temporal differences, lead to the view they are controlled by common neural mechanisms.

Posturographic testing and motor learning predictability in gymnasts

PURPOSE

One aim of this study was to find if there was a difference between balance and stability between elite level gymnasts and non-gymnasts. Another aim was to find if there was a relationship between dynamic posturographic scores associated with sway fatigue or adaptability and the ability to learn new gymnastic routines. The ultimate aim of the study was to improve gymnastic performance while reducing the probability of injury.

METHODS

Computer dynamic posturography (CDP) provided stability scores, fatigability ratios and adaptation ratios in elite level gymnasts and non-gymnasts controls. Relationships between the postural integrity of gymnasts and non-gymnasts were calculated. The gymnasts were trained in a novel gymnastic routine and performance outcomes were compared to the CDP outcomes.

RESULTS

Tests of postural stability have shown that gymnasts have greater postural stability than non-gymnasts. Gymnasts whose adaptability scores were higher were able to learn and perform new motor routines better than those with lower adaptability scores or high fatigability ratios.

CONCLUSIONS

While gymnasts have greater postural integrity than do non-gymnasts, CDP can identify individuals whose ability to perform new motor activities might be impaired. Methodology to improve functional stability not associated with the motor task may contribute to increased sports performance and decreased probability of injury.

The effect of voluntary arm abduction on balance recovery following multidirectional stance perturbations

The goal of this study was to investigate how voluntarily abducting one arm, 90 degrees at onset of a rotational perturbation of the support surface, influences the recovery of upright stance. Young adults were tested under four stance conditions: abducting one arm to the horizontal only (AO); perturbation of stance using a support surface rotation only (PO); combined support surface rotation and abduction of the downhill arm, ipsilateral to tilt (IPS); and fourth abduction of the uphill, contralateral arm (CON). Simultaneous auditory and visual trigger cues were used for arm raising. Perturbations consisted of six directions of combined support surface roll and pitch rotation (7.5 degrees and 60 degrees/s). Outcome measures were whole body centre of mass (COM) movements and body segment angular displacements recorded with a motion analysis system, as well as leg, trunk, and arm EMG responses. Arm raises contralateral and ipsilateral to the direction of support surface roll were more rapid than in the AO condition and significantly reduced or increased, respectively, COM lateral displacements relative to the PO condition. The changes in COM displacements and velocities during combined CON arm raise and perturbation were greater than expected from the sum of displacements for AO and PO conditions alone, but less for the IPS condition. Arm raising increased trunk roll in a direction opposite arm raising was more than for the AO and PO conditions. Robust effects were also observed for hip abduction but not for leg flexion. Early balance correcting activity was enhanced on the side opposite arm raising and later stabilising activity reduced bilaterally in lower trunk muscles compared to summed activity for the AO and PO conditions. Similar effects were observed in gluteus medius muscles but effects were weak in ankle muscles. EMG onsets in muscles of the raised arm were earlier than in the AO conditions. We conclude that triggered arm abduction, contralateral to the direction of support surface rotation, had significant stabilization benefits for young adults and ipsilateral arm movements had destabilizing effects. The arm raises could be simultaneously executed with balance corrections. These results provide insights into the integration of balance corrections and voluntary commands into one automatic reaction that may be useful in training fall avoidance.

Location specificity of plantar cutaneous reflexes involving lower limb muscles in humans

It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (approximately 70-110 ms, MLR) following non-noxious electrical stimulation to different locations on the plantar foot were recorded from 16 neurologically intact volunteers (15 males, 1 female). Electrical stimulation was given to the fore-medial (f-M), fore-lateral (f-L) and heel (HL) regions of the plantar surface of the right foot while the subjects performed isometric dorsiflexion (tibialis anterior, TA), plantarflexion (soleus, Sol and medial gastrocnemius, MG), eversion (peroneus longus, PL) and knee extension (vastus lateralis, VL) while sitting and standing. In the Sol and MG, an excitatory response was observed following HL stimulation, which was switched to an inhibitory response following f-M or f-L stimulation (P < 0.001). A reciprocal pattern in contrast to Sol was observed in the TA. In the PL, MLR exhibited significant excitation following both f-L and HL stimulation, which, however, was switched to an inhibitory response following f-M stimulation (P < 0.001). Moderate inhibition of the MLR was seen in the VL for all stimulated positions. Systematic stimulation along the lateral side of the plantar foot demonstrated that the reflex reversal occurred around the middle of the plantar foot in the Sol and TA. In all muscles tested, the slope of the regression line between the magnitude of the MLR and background electromyographic activity significantly decreased during standing compared with sitting except for the PL following f-L simulation. These results suggest that reflex effects from cutaneous nerves in the plantar foot onto the motoneurons innervating the lower leg muscles are organized in a highly topographic manner in humans. The organization of these reflexes may play an important role in the alteration of limb loading and/or ground contact in response to tactile sensation of the plantar foot while sitting and standing.