Diabetic older women without peripheral neuropathy amplify body sway but are capable of improving postural stability during a saccadic gaze task

BACKGROUND

Diabetic older people tend to present deteriorated performance in balance and locomotion activities, even those without peripheral neuropathy. There is evidence that saccadic eye movements are used to reduce body sway in young and older healthy adults, but it has not been shown that diabetic older people preserve this visuomotor adaptation capacity.

RESEARCH QUESTION

Are diabetic older women without peripheral neuropathy capable of improving postural stability during a saccadic gaze task?

METHODS

Seventeen type 2 diabetic older women (68.2 ± 10.7 years old) and seventeen healthy women, age-matched controls (66.0 ± 8.4 years old) voluntarily participated in the study. All participants were instructed to stand upright, barefoot, as stable as possible, for 30 s. Participants maintained their feet parallel to each other, at standard and narrow bases of support, while either fixating on a stationary target (fixation condition) or performing horizontal saccadic eye movements to follow a target (eccentricity of 11° of visual angle), which continuously disappeared and reappeared immediately on the opposite side (saccade 0.5 Hz and saccade 1.1 Hz conditions).

RESULTS

Results indicated that the diabetic group clearly had deteriorated postural control, as shown by increased values of mean sway amplitude and mean sway velocity. However, diabetic and control groups were similarly capable of using saccadic eye movements to improve their postural stability, reducing their sway velocity compared to a gaze fixation condition.

SIGNIFICANCE

Diabetes per se (without peripheral neuropathy) amplifies postural sway of older women as compared to their healthy age-matched controls. However, diabetic older women without peripheral neuropathy are capable of improving postural stability during a saccadic gaze task.

Coordination tending towards an anti-phase relationship determines greater sway reduction during entrainment with a simulated partner

The increased risk of falls in the older aged population demands the development of assistive robotic devices capable of effective balance support. For the development and increased user acceptance of such devices, which provide balance support in a human-like way, it is important to understand the simultaneous occurrence of entrainment and sway reduction in human-human interaction. However, sway reduction has not been observed yet during a human touching an external, continuously moving reference, which rather increased human body sway. Therefore, we investigated in 15 healthy young adults (27.20±3.55 years, 6 females) how different simulated sway-responsive interaction partners with different coupling modes affect sway entrainment, sway reduction and relative interpersonal coordination, as well as how these human behaviours differ depending on the individual body schema accuracy. For this, participants were lightly touching a haptic device that either played back an average pre-recorded sway trajectory ("Playback") or moved based on the sway trajectory simulated by a single-inverted pendulum model with either a positive (Attractor) or negative (Repulsor) coupling to participant's body sway. We found that body sway reduced not only during the Repulsor-interaction, but also during the Playback-interaction. These interactions also showed a relative interpersonal coordination tending more towards an anti-phase relationship, especially the Repulsor. Moreover, the Repulsor led to the strongest sway entrainment. Finally, a better body schema contributed to a reduced body sway in both the "reliable" Repulsor and the "less reliable" Attractor mode. Consequently, a relative interpersonal coordination tending more towards an anti-phase relationship and an accurate body schema are important to facilitate sway reduction.

The impact of eye movement on postural control depends on the type of oculomotor behavior and the visual task

Recent evidence suggests that performing a task inducing saccades will improve stability when compared to static fixation. However, they assume the linearity of postural control by only interpreting the area of displacement and/or the velocity of sway. Conversely, non-linear measures could bring a complementary understanding of postural control. The aim is to examine the effect of eye movements on different linear and non-linear measures of stability. 21 healthy adults (24.0 ± 3.3 years) were asked to stand on a force platform with their feet together and look at the monitor in front of them. Five conditions were tested: eyes closed, random looking, fixed static point, saccade, and visual pursuit (gaze shift angle of 15°). Five 60-second trials per condition were performed. An ANOVA with repeated measures was completed for each postural control variables in each direction: antero-posterior (AP) and medio-lateral (ML). The absence of vision had a negative impact on sway, as seen by an increase in sway area and variability as well as reduced contributions from the ultra-low band. The saccade led to greater stability than the random looking, as evidenced by a smaller area. However, the visual pursuit led to decreased stability compared to random looking, as evidenced by a larger area, as well as increased variability. Of note, the energy contained in the very-low band, which indicates the contribution of the vestibular system, was highest in the visual pursuit compared to the fixed static point. The findings support that the visual system is an important, but complex contributor to stability as different eye movements result in distinct postural responses with saccade and visual pursuit causing a decrease and an increase in sway, respectively.

Effects of spatial working memory capacity and resolution loads on postural stability while dual-tasking

Increased spatial processing demands, e.g., working memory loads, which include capacity load and resolution load, may interfere with postural stability. To date, there has been little evidence to demonstrate whether capacity load and resolution load affect postural stability. Therefore, this study manipulated capacity load and resolution load in a spatial working memory task to examine how postural stability is affected. Sixteen healthy young participants were tested in a dual-task paradigm that consisted of a postural task with a tandem Romberg stance and a spatial working memory task with different capacity loads and resolution loads in different sessions. Participants were required to detect a salient change (45° in low resolution) or a subtle change (15° in high resolution) in the bar orientation as a resolution load. Capacity load was manipulated by storing the number of bars, with two bars in low capacity and four in high capacity. The results showed significant interactions between capacity load and resolution load on dual-task effects of sway velocity. In the low-resolution condition, the dual-task effects of anteroposterior and mediolateral sway velocity were significantly lower in the high capacity than in the low capacity, yet no significant differences occurred in the high-resolution load condition. Our results suggest that increased capacity loads interfere with postural stability only in low-resolution loads while dual-tasking.

Effects of mentally induced fatigue on balance control: a systematic review

The relationship between cognitive demands and postural control is controversial. Mental fatigue paradigms investigate the attentional requirements of postural control by assessing balance after a prolonged cognitive task. However, a majority of mental fatigue research has focused on cognition and sports performance, leaving balance relatively underexamined. The purpose of this paper was to systematically review the existing literature on mental fatigue and balance control. We conducted a comprehensive search on PubMed and Web of Science databases for studies comparing balance performance pre- to post-mental fatigue or between a mental fatigue and control group. The literature search resulted in ten relevant studies including both volitional (n = 7) and reactive (n = 3) balance measures. Mental fatigue was induced by various cognitive tasks which were completed for 20-90 min prior to balance assessment. Mental fatigue affected both volitional and reactive balance, resulting in increased postural sway, decreased accuracy on volitional tasks, delayed responses to perturbations, and less effective balance recovery responses. These effects could have been mediated by the depletion of attentional resources or impaired sensorimotor perception which delayed appropriate balance-correcting responses. However, the current literature is limited by the number of studies and heterogeneous mental fatigue induction methods. Future studies are needed to confirm these postulations and examine the effects of mental fatigue on different populations and postural tasks. This line of research could be clinically relevant to improve safety in occupational settings where individuals complete extremely long durations of cognitive tasks and for the development of effective fall-assessment and fall-prevention paradigms.

Decreased Saccadic Eye Movement Speed Correlates with Dynamic Balance in Older Adults

This study aimed to determine the change in saccadic eye movement (SEM) speed according to age (young older; 65–72 years, middle older; 73–80 years, old older: over 81 years) in the elderly and identify the correlation between SEM speed and balance ability. We recruited 128 elderly individuals and measured their SEM speed and balance. The SEM speed was measured to allow the target to appear once every 2 s (0.5 Hz), twice per second (2 Hz), or thrice per second (3 Hz). The SEM performance time was 1 min with a washout period of 1 min. Balance ability was measured using the functional reach test (FRT), timed up-and-go test (TUG), and walking speed (WS). As age increased, FRT, TUG, and WS decreased and SEM speed was significantly decreased in old older than in young older adults at 3 HZ. In all participants, the 3 Hz SEM speed was significantly correlated with TUG and WS. Therefore, SEM speed may be inadequate or decreased in response to rapid external environmental stimuli and may be a factor that deteriorates the ability to balance in older adults.

Sex differences in the association of postural control with indirect measures of body representations

Besides anthropometric variables, high-order body representations have been hypothesised to influence postural control. However, this has not been directly tested before. Moreover, some studies indicate that sex moderates the relationship of anthropometry and postural control. Therefore, as a proof of concept we investigated the association of body representations with postural control as well as the influence of participants’ sex/gender. Body image measures were assessed with a figural drawing task. Body schema was tested by a covert and an overt task. Body sway was measured during normal bipedal quiet standing with eyes closed (with/without neck extended). Statistical analysis consisted of hierarchical multiple linear regressions with the following regression steps: (1) sensory condition, (2) sex/gender, (3) age, (4) anthropometry, (5) body schema, (6) body image, (7) sex/gender-interactions. Across 36 subjects (19 females), body schema was significantly associated with body sway variability and open-loop control, in addition to commonly known influencing factors, such as sensory condition, gender, age and anthropometry. While in females, also body image dissatisfaction substantially was associated with postural control, this was not the case in males. Sex differences and possible causes why high-order body representations may influence concurrent sensorimotor control of body sway are discussed.

Trunk and head displacements stabilized to perform both horizontal and vertical saccadic eye movements

Vision is crucial for humans to interact with their surrounding environment, and postural sway is reduced to allow short eye movements. However, the extent of subtle changes in postural control for horizontal and vertical eye movements remains unclear. The goal of this study was to investigate the effects of vertical and horizontal eye movements on head and trunk control in young adults. Fifteen healthy adults (23.4 ± 4.7 years) stood upright in three conditions for 60 s: fixation, horizontal, and vertical guided eye movements. In fixation, participants had to fixate on a stationary target. In both the horizontal and vertical eye movements, the target was presented with a frequency of 0.5 Hz and a visual angle of 11°. Eye displacement was monitored using a SMI eye tracker (ETG2.0) and trunk and head sway were monitored using infrared markers (Optotrak 3020, NDI). The mean sway amplitude was lower in both directions for eye movements and lowest in the vertical direction compared to the fixation condition. The sway area was also lower in vertical eye movement than in the fixation condition. We also found that the sway reduction was greater at head than at trunk level. The median frequency sway in the anterior-posterior direction was higher in both eye movements than in fixation. Based upon these results, we suggest that to perform short eye movements, postural sway is more strongly controlled at the head level than at the trunk and in vertical eye movements than in horizontal movements.

Saccadic eye movement performance reduces visual manipulation influence and center of pressure displacements in older fallers

This study examined changes in postural control and gaze performance of faller and non-faller older adults under conditions of visual tasks and optical flow manipulations. Fifteen older non-fallers (69.8 years, ± 3.2) and fifteen older fallers (71.1 years, ± 6.4) stood on a force platform inside a moving room wearing an eye tracker. Four tasks were performed: gaze fixation; predictable saccades; unpredictable saccades; and free-viewing. The stimuli appeared at a frequency of 1.1 Hz during conditions of predictable and unpredictable saccades. Sixteen trials were divided into two blocks. In the first block, the room remained stationary. In the second block, the room oscillated, without the participant's awareness, with a 0.6 cm amplitude and 0.2 Hz frequency. Results showed postural sway attenuation in older fallers during the saccadic tasks compared to gaze fixation and free-viewing tasks, in both stationary and moving room conditions. Both groups showed increased center of pressure (CoP) magnitude during the moving room condition and CoP displacements strongly coupled to the room's movement. The influence of the moving room on the postural sway was reduced during the saccadic tasks for both older groups. Older fallers exhibited higher variability compared to older non-fallers. Gaze behavior differences between groups were dependent on the goals of the visual tasks. Therefore, CoP displacements of older adults are reduced during saccadic tasks regardless of their falling history. However, postural and gaze performance of older fallers suggests increased deterioration of postural and oculomotor control which may be used as a predictor of fall risk.

Variability of visually-induced center of pressure displacements is reduced while young adults perform unpredictable saccadic eye movements inside a moving room

This study investigated the modulation of center of pressure (CoP) displacements of young adults as they performed predictable and unpredictable saccadic eye movements in stationary and moving visual scenarios. We also examined whether the relationship between CoP displacements and visual stimulus, provided by the moving scenario, and gaze control itself, are affected by the demands of the saccadic tasks. Fifteen young adults (20.53 ± 2.1 years old) stood upright on a force plate, inside a moving room, wearing an eye tracker while performing three tasks: gaze fixation (fixating on a target in the center of the screen), predictable task (saccades while following a target which continuously appeared and disappeared on the right and left sides), and unpredictable task (similar to the previous task, but the participants did not know which side the target would appear on). For saccadic tasks, the target appeared at a frequency of 1.1 Hz and with eccentricity of 11.5 degrees of visual angle. Two blocks of six trials were performed: in the first block, the room remained stationary and in the second, it oscillated (0.6 cm amplitude; 0.2 Hz frequency). Mean amplitude of CoP displacements was lower in the saccadic tasks compared to the gaze fixation, in both conditions; and higher in the moving scenario than in the stationary condition. Variability of CoP displacements was lower in the unpredictable saccades than gaze fixation task. Saccade reaction time was longer in the unpredictable than predictable task. We conclude that CoP displacements are reduced to facilitate performance of the saccadic tasks regardless of conditions and task complexity. Furthermore, lower variability suggests modulation of CoP displacements to deal with the increased attentional demands associated with the performance of the unpredictable saccades, indicating the important role of visual task constraints in postural control.

In the upright stance, posture is better controlled to perform precise visual tasks than laser pointing tasks

PURPOSE

In the upright stance, young adults better stabilize their posture when they perform precise visual or pointing movements than when they stand quietly. We tested if postural stability could be improved further if precise and pointing tasks were combined.

METHOD

Twenty-four healthy young adults (22 ± 12 years) performed six tasks combining three visual tasks (precise search, unprecise free-viewing and fixation tasks) and two pointing tasks (pointing-on and pointing-off tasks with laser beam on and off, respectively). In the visual tasks, participants either searched to locate targets within an image (precise task), looked at the image with no goal (unprecise task) or fixated on a cross (fixation task). In the pointing-on tasks, participants pointed a laser beam onto a small circle (2°) located in the middle of a larger circle (21°) containing the image.

RESULT

As expected, postural sway was reduced in the precise tasks in contrast to the fixation tasks. Contrary to expectations, both precise and pointing-on tasks did not add their stabilizing effects. Furthermore, the pointing-on task almost did not influence body movements. The participants rotated their eyes and head more and their upper back less in the precise visual tasks than in the unprecise visual tasks.

CONCLUSION

The participants used a stabilizing coordination to fully explore images with eye and head rotations while stabilizing their body to perform precise gaze shifts. Our findings suggest that posture stabilization is performed to facilitate success in precise visual tasks more so than to perform pointing-on tasks.

Visual effort moderates postural cascade dynamics

Standing still and focusing on a visible target in front of us is a preamble to many coordinated behaviors (e.g., reaching an object). Hiding behind its apparent simplicity is a deep layering of texture at many scales. The task of standing still laces together activities at multiple scales: from ensuring that a few photoreceptors on the retina cover the target in the visual field on an extremely fine scale to synergies spanning the limbs and joints at smaller scales to the mechanical layout of the ground underfoot and optic flow in the visual field on the coarser scales. Here, we used multiscale probability density function (PDF) analysis to show that postural fluctuations exhibit similar statistical signatures of cascade dynamics as found in fluid flow. In participants asked to stand quietly, the oculomotor strain of visually fixating at different distances moderated postural cascade dynamics. Visually fixating at a comfortable viewing distance elicited posture with a similar cascade dynamics as posture with eyes closed. Greater viewing distances known to stabilize posture showed more diminished cascade dynamics. In contrast, nearest and farthest viewing distances requiring greater oculomotor strain to focus on targets elicited a dramatic strengthening of postural cascade dynamics, reflecting active postural adjustments. Critically, these findings suggest that vision stabilizes posture by reconfiguring the prestressed poise that prepares the body to interact with different spatial layouts.

Comparison of Postural Sway, Plantar Cutaneous Sensation According to Saccadic Eye Movement Frequency in Young Adults

The crossover trial study aimed to identify the saccadic eye movement (SEM) frequency to improve postural sway (PS) and plantar cutaneous sensation (PUS) in young adults. The 17 participants randomly performed 0.5-, 2-, and 3-Hz SEM. The SEM frequency was determined to allow the target to appear once per 2 s (0.5 Hz), twice per second (2 Hz), or thrice per second (3 Hz). SEM performance time was 3 min with a washout period of 5 min. PS and PUS were measured at baseline and during 0.5-Hz, 2-Hz, and 3-Hz SEMs using a Zebris FDM 1.5 force plate. PS was determined by measuring the sway area, path length, and speed of center of pressure (COP) displacement, and PUS was determined via the plantar surface area (PSA). In PS parameters, there was a significant difference among the SEM frequencies in the COP_{sway area} PSA_{left foot} and PSA_{right foot}. Compared to that at baseline, COP_{sway area} decreased at 0.5 Hz and 2 Hz, while PSA_{left foot} and PSA_{right foot} increased at 2 Hz. These results suggest that 2 Hz SEM may improve PS and PSA.

Visually guided eye movements reduce postural sway in dyslexic children

Dyslexic children present poorer postural control performance than their peers, perhaps due to different patterns of eye movements. It has been shown that guided eye movements decrease magnitude of body sway in young and older adults, but there is no evidence whether the search for visual information that occurs during eye movements affects postural control in dyslexic children. The aim of this study was to examine the use of guided eye movements and its pattern in the performance of postural control of dyslexic children during upright quiet stance. Twelve children with dyslexia (10.8 ± 1.1 years old) and 12 non-dyslexic children (10.4 ± 1.5 years old) participated in this study. All children were instructed to maintain an upright quiet stance for 60 s either fixating on a target (fixation condition) displayed 1 m ahead in the center of a monitor at eye level, or performing eye movements to follow a target displayed on one side of a monitor, then disappearing and reappearing immediately on the opposite side with a frequency of 0.5 Hz (guided condition). Three trials for each condition were registered. Body sway was measured with an IRED (OPTOTRAK) placed on the children's back. Eye movements were tracked using eye-tracking glasses (ETG 2.0 - SMI). Dyslexic children swayed with larger amplitude under both fixation and guided conditions than non-dyslexic children. Both dyslexic and non-dyslexic children reduced postural sway magnitude under the guided compared to the fixation condition. All children were able to modulate eye movement according to the conditions (fixation and guided) and no difference in eye movements was observed between dyslexic and non-dyslexic children. Eye movements are modulated similarly based upon the visual conditions in dyslexic and non-dyslexic children, and dyslexic children are capable of using available visual information during eye movements to improve postural control, though they do not equal the performance of non-dyslexic children. Eye movement patterns seem not to be related to poor performance of postural control in dyslexic children.

Wearing a head-mounted eye tracker may reduce body sway

This study investigated the effects of wearing a head-mounted eye tracker on upright balance during different visual tasks. Twenty five young adults stood upright on a force plate while performing the visual tasks of fixation, horizontal saccades, and eyes closed, during eighteen trials wearing or not a head-mounted eye tracker. While wearing the eye tracker, participants showed a reduction in mean sway amplitude and velocity of the CoP in the AP and ML directions and more regular CoP fluctuations, in the ML axis in all conditions. Higher mean sway amplitude and velocity of CoP were observed during eyes closed than fixation and saccades. Moreover, horizontal saccades reduced mean sway velocity of CoP compared to fixation. Therefore, wearing the eye tracker minimized the body sway of young adults; however, visual task-related effects on postural stability remained unchanged.

Semi tandem base of support degrades both saccadic gaze control and postural stability particularly in older adults

Differences in the postural stabilization of older and young adults have been shown to be task-dependent on both visual and postural challenges; however, the gaze behavior during such tasks has rarely been examined. This study investigated the effects of horizontal and vertical saccades on gaze control, center of pressure (CoP) and head displacement of young and older adults on different bases of support. Ten young adults (20.7 ± 3.4 years) and ten older adults (71.6 ± 3.1 years) remained in an upright stance on a force platform wearing an eye-head tracker device. The participants performed 30-second trials according to two bases of support (feet apart and semi-tandem) and three gaze behavior (fixation, horizontal and vertical saccades) conditions. Older adults presented greater CoP amplitude (p < 0.002) and velocity (p < 0.001) (ML axis), and higher head amplitude (ML) (p < 0.002) than young adults during the semi tandem base. Head displacement of both groups presented higher velocity (ML axis) during horizontal (p < 0.001) and vertical saccades (p < 0.01) than the fixation task only on the semi tandem base. There was higher number of fixations (p < 0.001) and lower mean fixation duration (p < 0.001) on the semi-tandem base (p < 0.05). The results showed higher gaze latency variability in vertical saccades for older adults (p < 0.01). Challenging postural tasks may alter postural adjustments and gaze control during saccadic tasks. Particularly, the greater postural instability of older adults increased the gaze latency variability during saccadic tasks, suggesting some deterioration in the posture-gaze relation with aging.

Effects of Ankle Muscle Fatigue and Visual Behavior on Postural Sway in Young Adults

Ankle muscle fatigue has been shown to increase body sway. In addition, body sway in quiet upright standing is reduced when saccadic eye movements are performed. The purpose of this study was to investigate the effects of visual information manipulation on postural control during ankle muscle fatigue in young adults. Twenty young adults performed: (1) two 60-s trials in quiet bipedal standing with eyes open, eyes closed, and while performing saccadic eye movements; (2) maximum voluntary isometric contractions in a leg press device, custom-made to test ankle plantar flexion force; (3) a calf raise exercise on top of a step to induce ankle muscle fatigue; and (4) a repetition of items 1 and 2. Postural sway parameters were compared with two-way ANOVAs (vision condition × fatigue; p < 0.05). Ankle muscle fatigue increased anterior-posterior and medial-lateral displacement and RMS of sway, as well as sway area. Saccadic eye movements reduced anterior-posterior displacement and RMS of sway and area of sway compared to eyes open and eyes closed conditions. Both saccadic eye movements and eyes closed increased the frequency of AP sway compared to the eyes open condition. Finally, anterior-posterior displacement, anterior-posterior RMS, and both anterior-posterior and medial-lateral sway frequency were affected by an interaction of fatigue and vision condition. Without muscle fatigue, closing the eyes increased anterior-posterior displacement and RMS of sway, compared to eyes open, while during muscle fatigue closing the eyes closed reduced anterior-posterior displacement and had no significant effect on anterior-posterior RMS. In conclusion, body sway was increased after induction of ankle muscle fatigue. Saccadic eye movements consistently reduced postural sway in fatigued and unfatigued conditions. Surprisingly, closing the eyes increased sway in the unfatigued condition but reduced sway in the fatigued condition.

How Eye Movements Stabilize Posture in Patients With Bilateral Vestibular Hypofunction

Chronic patients with bilateral vestibular hypofunction (BVH) complain of oscillopsia and great instability particularly when vision is excluded and on irregular surfaces. The real nature of the visual input substituting to the missing vestibular afferents and improving posture control remains however under debate. Is retinal slip involved? Do eye movements play a substantial role? The present study tends to answer this question in BVH patients by investigating their posture stability during quiet standing in four different visual conditions: total darkness, fixation of a stable space-fixed target, and pursuit of a visual target under goggles delivering visual input rate at flicker frequency inducing either slow eye movements (4.5 Hz) or saccades (1.2 Hz). Twenty one chronic BVH patients attested by both the caloric and head impulse test were examined by means of static posturography, and compared to a control group made of 21 sex-and age-matched healthy participants. The posturography data were analyzed using non-linear computation of the center of foot pressure (CoP) by means of the wavelet transform (Power Spectral Density in the visual frequency part, Postural Instability Index) and the fractional Brownian-motion analysis (stabilogram-diffusion analysis, Hausdorff fractal dimension). Results showed that posture stability was significantly deteriorated in darkness in the BVH patients compared to the healthy controls. Strong improvement of BVH patients' posture stability was observed during fixation of a visual target, pursuit with slow eye movements, and saccades, whereas the postural performance of the control group was less affected by the different visual conditions. It is concluded that BVH patients improve their posture stability by (1) using extraocular signals from eye movements (efference copy, muscle re-afferences) much more than the healthy participants, and (2) shifting more systematically than the controls to a more automatic mode of posture control when they are in dual-task conditions associating the postural task and a concomitant visuo- motor task.

Effects of breathing movement on the reduction of postural sway during postural-cognitive dual tasking

An execution of cognitive processing interferes with postural sway during quiet standing. It reduces sway variability in young adults, but the mechanism is not clear. To elucidate the mechanisms, we focused on breathing in the present study. The purpose of this study was to clarify whether a decrease in postural sway amplitude during a postural-cognitive task is related to the change in breathing movement. The center of pressure (COP) was recorded via a force plate and the motion of leg joints (ankle, knee, and hip), and breathing movements were measured with a 3D motion capture system in quiet standing and standing with cognitive (mental arithmetic) task conditions. The change ratios of each variable from the quiet standing condition to the cognitive task were also calculated. It was shown that the MASt condition produced a significantly smaller RMS of COP displacement as compared to the QSt condition (p < 0.01). The results revealed that the breathing rate was faster and the amplitude of breathing movement smaller when subjects performed the cognitive task. A significant positive correlation (r = 0.75, p < 0.01) was found between the change ratio of breathing amplitude and the COP amplitude. The present results suggest that reduced standing postural sway during a cognitive task is related, at least in part, to a decrease in breathing amplitude.

Gaze position interferes in body sway in young adults

Postural control is influenced by eye movements. Gaze fixation, which comprises a component of ocular vergence, is important in the acquisition of highly specific task information, but its relation to postural control is little investigated. The aim of the study was to investigate the effects of gaze fixation position (central and lateral fixations) on postural sway in young adults. Forty young adults with ages ranging from 20 to 35 years were invited to participate in the study. Postural sway was measured in quiet stance in bipedal support in three 60-s trials under the following conditions: gaze fixation on a target positioned in front of participant, gaze fixation on a target positioned on right side of participant, and gaze fixation on a target positioned on left side of participant. The following center of pressure parameters (COP) in the anteroposterior (AP) and mediolateral directions (ML) were analyzed for each of the trials: body sway displacement, mean velocity of sway, root mean square (RMS) of sway, and median frequency. In addition, detrended fluctuation analysis (DFA) exponent, in anteroposterior and medio-lateral directions, was calculated. The COP presented greater AP and ML displacement (p<0.03, effect size=1.37; and p<0.03, effect size=1.64, respectively) and RMS AP and ML (p<0.04, effect size=1.66; and p<0.02, effect size=2.50, respectively) for lateral gaze fixation compared to central gaze fixation. These results suggest that gaze fixation on a laterally positioned target increases body sway in anteroposterior and mediolateral directions.

Saccadic Eye Movement Improves Plantar Sensation and Postural Balance in Elderly Women

Vision, proprioception and plantar sensation contribute to the control of postural balance (PB). Reduced plantar sensation alters postural response and is at an increased risk of fall, and eye movements reduce the postural sway. Therefore, the aim of this study was to study the improvement of plantar sensation and PB after saccadic eye movement (SEM) and pursuit eye movement (PEM) in community-dwelling elderly women. Participants (104 females; 75.11 ± 6.25 years) were randomly allocated into the SEM group (n = 52) and PEM groups (n = 52). The SEM group performed eye fixation and SEM for 5 minutes, and the PEM group performed eye fixation and PEM for 5 minutes. The plantar sensation was measured according to the plantar surface area of the feet in contact with the floor surface before and after the intervention. Before and after SEM and PEM with the eyes open and closed, PB was measured as the area (mm(2)), length (cm), and velocity (cm/s) of the fluctuation of the center of pressure (COP). The plantar sensation of both feet improved in both groups (p < 0.01). Significant decreases in the area, length, and velocity of the COP were observed in the eye open and close in both groups (p < 0.01). The length and velocity of the COP significantly decreased in the SEM group compared to the PEM group (p < 0.05). In conclusion, SEM and PEM are effective interventions for improving plantar sensation and PB in elderly women, with greater PB improvement after SEM.

Interaction between the oculomotor and postural systems during a dual-task: Compensatory reductions in head sway following visually-induced postural perturbations promote the production of accurate double-step saccades in standing human adults

Humans routinely scan their environment for useful information using saccadic eye movements and/or coordinated movements of the eyes and other body segments such the head and the torso. Most previous eye movement studies were conducted with seated subject and showed that single saccades and sequences of saccades (e.g. double-step saccades) made to briefly flashed stimuli were equally accurate and precise. As one can easily appreciate, most gaze shifts performed daily by a given person are not produced from a seated position, but rather from a standing position either as subjects perform an action from an upright stance or as they walk from one place to another. In the experiments presented here, we developed a new dual-task paradigm in order to study the interaction between the gaze control system and the postural system. Healthy adults (n = 12) were required to both maintain balance and produce accurate single-step and double-step eye saccades from a standing position. Visually-induced changes in head sway were evoked using wide-field background stimuli that either moved in the mediolateral direction or in the anteroposterior direction. We found that, as in the seated condition, single- and double-step saccades were very precise and accurate when made from a standing position, but that a tighter control of head sway was necessary in the more complex double-step saccades condition for equivalent results to be obtained. Our perturbation results support the "common goal" hypothesis that state that if necessary, as was the case during the more complex oculomotor task, context-dependent modulations of the postural system can be triggered to reduced instability and therefore support the accomplishment of a suprapostural goal.

The Stationary-Gaze Task Should Not Be Systematically Used as the Control Task in Studies of Postural Control

In studies of postural control, a control task is often used to understand significant effects obtained with experimental manipulations. This task should be the easiest task and (therefore) engage the lowest behavioral variability and cognitive workload. Since 1983, the stationary-gaze task is considered as the most relevant control task. Instead, the authors expected that free looking at small targets (white paper or images; visual angle: 12°) could be an easier task. To verify this assumption, 16 young individuals performed stationary-gaze, white-panel, and free-viewing 12° tasks in steady and relaxed stances. The stationary-gaze task led to significantly higher cognitive workload (mean score in the National Aeronotics and Space Administration Task Load Index questionnaire), higher interindividual body (head, neck, and lower back) linear variability, and higher interindividual body angular variability-not systematically yet-than both other tasks. There was more cognitive workload in steady than relaxed stances. The authors also tested if a free-viewing 24° task could lead to greater angular displacement, and hence greater body sway, than could the other tasks in relaxed stance. Unexpectedly, the participants mostly moved their eyes and not their body in this task. In the discussion, the authors explain why the stationary-gaze task may not be an ideal control task and how to choose this neutral task.

Postural Control Can Be Well Maintained by Healthy, Young Adults in Difficult Visual Task, Even in Sway-Referenced Dynamic Conditions

Purpose

To challenge the validity of existing cognitive models of postural control, we recorded eye movements and postural sway during two visual tasks (a control free-viewing task and a difficult searching task), and two postural tasks (one static task in which the platform was maintained stable and a dynamic task in which the platform moved in a sway-referenced manner.) We expected these models to be insufficient to predict the results in postural control both in static–as already shown in the literature reports–and in dynamic platform conditions.

Methods

Twelve healthy, young adults (17.3 to 34.1 years old) participated in this study. Postural performances were evaluated using the Multitest platform (Framiral®) and ocular recording was performed with Mobile T2 (e(ye)BRAIN®). In the free-viewing task, the participants had to look at an image, without any specific instruction. In the searching task, the participants had to look at an image and also to locate the position of an object in the scene.

Results

Postural sway was only significantly higher in the dynamic free-viewing condition than in the three other conditions with no significant difference between these three other conditions. Visual task performance was slightly higher in dynamic than in static conditions.

Discussion

As expected, our results did not confirm the main assumption of the current cognitive models of postural control–i.e. that the limited attentional resources of the brain should explain changes in postural control in our conditions. Indeed, 1) the participants did not sway significantly more in the sway-referenced dynamic searching condition than in any other condition; 2) the participants swayed significantly less in both static and dynamic searching conditions than in the dynamic free-viewing condition. We suggest that a new cognitive model illustrating the adaptive, functional role of the brain to control upright stance is necessary for future studies.

Eye Movements Affect Postural Control in Young and Older Females

Visual information is used for postural stabilization in humans. However, little is known about how eye movements prevalent in everyday life interact with the postural control system in older individuals. Therefore, the present study assessed the effects of stationary gaze fixations, smooth pursuits, and saccadic eye movements, with combinations of absent, fixed and oscillating large-field visual backgrounds to generate different forms of retinal flow, on postural control in healthy young and older females. Participants were presented with computer generated visual stimuli, whilst postural sway and gaze fixations were simultaneously assessed with a force platform and eye tracking equipment, respectively. The results showed that fixed backgrounds and stationary gaze fixations attenuated postural sway. In contrast, oscillating backgrounds and smooth pursuits increased postural sway. There were no differences regarding saccades. There were also no differences in postural sway or gaze errors between age groups in any visual condition. The stabilizing effect of the fixed visual stimuli show how retinal flow and extraocular factors guide postural adjustments. The destabilizing effect of oscillating visual backgrounds and smooth pursuits may be related to more challenging conditions for determining body shifts from retinal flow, and more complex extraocular signals, respectively. Because the older participants matched the young group's performance in all conditions, decreases of posture and gaze control during stance may not be a direct consequence of healthy aging. Further research examining extraocular and retinal mechanisms of balance control and the effects of eye movements, during locomotion, is needed to better inform fall prevention interventions.

Active vision task and postural control in healthy, young adults: Synergy and probably not duality

In upright stance, individuals sway continuously and the sway pattern in dual tasks (e.g., a cognitive task performed in upright stance) differs significantly from that observed during the control quiet stance task. The cognitive approach has generated models (limited attentional resources, U-shaped nonlinear interaction) to explain such patterns based on competitive sharing of attentional resources. The objective of the current manuscript was to review these cognitive models in the specific context of visual tasks involving gaze shifts toward precise targets (here called active vision tasks). The selection excluded the effects of early and late stages of life or disease, external perturbations, active vision tasks requiring head and body motions and the combination of two tasks performed together (e.g., a visual task in addition to a computation in one's head). The selection included studies performed by healthy, young adults with control and active - difficult - vision tasks. Over 174 studies found in Pubmed and Mendeley databases, nine were selected. In these studies, young adults exhibited significantly lower amplitude of body displacement (center of pressure and/or body marker) under active vision tasks than under the control task. Furthermore, the more difficult the active vision tasks were, the better the postural control was. This underscores that postural control during active vision tasks may rely on synergistic relations between the postural and visual systems rather than on competitive or dual relations. In contrast, in the control task, there would not be any synergistic or competitive relations.

The role of central vision in posture: Postural sway adaptations in Stargardt patients

The role of central and peripheral vision in the maintenance of upright stance is debated in literature. Stargardt disease causes visual deficits affecting the central field, but leaving unaltered a patient's peripheral vision. Hence, the study of this rare pathology gives the opportunity to selectively investigate the role of central vision in posture. Postural sway in quiet stance was analyzed in 10 Stargardt patients and 10 control subjects, in three different conditions: (1) eyes closed, (2) eyes open, gazing at a fixed target, and (3) eyes open, tracking a moving target. Stargardt patients outperformed controls in the condition with eyes closed, showing a reduced root mean square (RMS) of the medio-lateral COP displacement, while their performance was not significantly different from controls in the antero-posterior direction. There were no significant differences between patients and controls in open eyes conditions. These results suggest that Stargardt patients adapted to a different visual-somatosensory integration, relying less on vision, especially in the medio-lateral direction. Hence, the central vision seems to affect mostly the medio-lateral direction of postural sway. This finding supports the plausibility of the "functional sensitivity hypothesis", that assigns complementary roles to central and peripheral vision in the control of posture.

Effects of light touch on postural sway and visual search accuracy: A test of functional integration and resource competition hypotheses

People often multi-task in their daily life. However, the mechanisms for the interaction between simultaneous postural and non-postural tasks have been controversial over the years. The present study investigated the effects of light digital touch on both postural sway and visual search accuracy for the purpose of assessing two hypotheses (functional integration and resource competition), which may explain the interaction between postural sway and the performance of a non-postural task. Participants (n=42, 20 male and 22 female) were asked to inspect a blank sheet of paper or visually search for target letters in a text block while a fingertip was in light contact with a stable surface (light touch, LT), or with both arms hanging at the sides of the body (no touch, NT). The results showed significant main effects of LT on reducing the magnitude of postural sway as well as enhancing visual search accuracy compared with the NT condition. The findings support the hypothesis of function integration, demonstrating that the modulation of postural sway can be modulated to improve the performance of a visual search task.

Saccadic and smooth pursuit eye movements attenuate postural sway similarly

Saccadic eye movements reduce body sway, yet visually pursuing a moving dot seems to increase body sway. However, how these two types of eye movements affect postural control remains ambiguous, particularly for smooth pursuit eye movements. The aim of this study was to examine the effects of saccade and smooth pursuit eye movements on body sway magnitude during low and high frequencies. Ten young adults (19.5 ± 1.9 years) participants were required to stand upright, barefoot for 70s using a bipedal stance, with feet hip width apart, fixating or pursuing a target that was displayed on a monitor positioned 100 cm away from their eyes. Each participant performed three trials using both types of eye movements, in particular, slow and fast saccades, and slow and fast smooth pursuit movements. Body sway was obtained using reflective markers attached to a participant's head and trunk, which were recorded by two video cameras. The results indicated that body sway was reduced during both saccadic eye movements and smooth pursuit movements when compared to fixation, independent of visual frequencies. These results suggested similarities in the control of saccades and smooth pursuit on postural control.

Postural mechanisms to control body displacements in the performance of lateral gaze shifts

Medialateral postural control mechanisms (bodyweight distribution and center of pressure location) have been studied in static conditions. Our objective was to determine how these mechanisms are adjusted to perform voluntary movements, in our case 80° lateral gaze shifts at 0.125 Hz and 0.25 Hz. In healthy, young adults, we expected body marker (neck, lower back) and center of pressure displacements to be significantly greater in gaze shift conditions than in the stationary gaze condition. To explain these changes in center of pressure displacement, the amplitude contribution of both mechanisms was expected to increase significantly. All these results were found accordingly. Unexpectedly, the active contribution of the bodyweight distribution mechanism was negatively related to body marker displacements in the gaze shift conditions (ns in stationary condition). Moreover, changes in the contribution of the mechanisms were statistically weaker in effect size than changes in body displacement. However, the participants were not unstable because they performed the visual tasks as requested. We propose that the strength of medialateral postural control mechanisms may not only be strengthened to control challenging ML stance conditions but also slightly weakened to allow the performance of adequate body motions in ongoing tasks.

Children's head movements and postural stability as a function of task

Manual dexterity and postural control develop throughout childhood, leading to changes in the synergistic relationships between head, hand and posture. But the postural developments that support complex manual task performance (i.e. beyond pointing and grasping) have not been examined in depth. We report two experiments in which we recorded head and posture data whilst participants simultaneously performed a visuomotor task. In Experiment 1, we explored the extent to which postural stability is affected by concurrently performing a visual and manual task whilst standing (a visual vs. manual-tracking task) in four age groups: 5-6 years (n = 8), 8-9 years (n = 10), 10-11 years (n = 7) and 19-21 years (n = 9). For visual tracking, the children's but not adult's postural movement increased relative to baseline with a larger effect for faster moving targets. In manual tracking, we found greater postural movement in children compared to adults. These data suggest predictive postural compensation mechanisms develop during childhood to improve stability whilst performing visuomotor tasks. Experiment 2 examined the extent to which posture is influenced by manual activity in three age groups of children [5-6 years (n = 14), 7-8 years (n = 25), and 9-10 years (n = 24)] when they were seated, given that many important tasks (e.g. handwriting) are learned and performed whilst seated. We found that postural stability varied in a principled manner as a function of task demands. Children exhibited increased stability when tracing a complex shape (which required less predictive postural adjustment) and decreased stability in an aiming task (which required movements that were more likely to perturb posture). These experiments shed light on the task-dependant relationships that exist between postural control mechanisms and the development of specific types of manual control.

Saccades improve postural control: a developmental study in normal children

INTRODUCTION

Dual-task performance is known to affect postural stability in children. This study focused on the effect of oculomotor tasks like saccadic eye movements on postural stability, studied in a large population of children by recording simultaneously their eye movements and posture.

MATERIALS AND METHODS

Ninety-five healthy children from 5.8 to 17.6 years old were examined. All children were free of any vestibular, neurological, ophtalmologic and orthoptic abnormalities. Postural control was measured with a force platform TechnoConcept®, and eye movements with video oculography (MobilEBT®). Children performed two oculomotor tasks: fixation of a stable central target and horizontal saccades. We measured the saccade latency and the number of saccades during fixation as well as the surface, length and mean velocity of the center of pressure.

RESULTS

During postural measurement, we observed a correlation between the age on the one hand and a decrease in saccade latency as well as an improvement in the quality of fixation on the other. Postural sway decreases with age and is reduced in the dual task (saccades) in comparison with a simple task of fixation.

DISCUSSION - CONCLUSION

These results suggest a maturation of neural circuits controlling posture and eye movements during childhood. This study also shows the presence of an interaction between the oculomotor system and the postural system. Engaging in oculomotor tasks results in a reduction of postural sway.

Effects of saccadic eye movements on postural control stabilization

Several structures of the central nervous system share involvement in both ocular and postural control, but the visual mechanisms in postural control are still unclear. There are discrepant evidences on whether saccades would improve or deteriorate stabilization of posture. The purpose of this study was to determine the influence of saccadic eye movements on postural control while standing in different basis of support. Twelve young adults stood upright in wide and narrow stances while performing fixation and saccades of low and high frequencies. Body sway was attenuated during saccades. Trunk anterior-posterior sway and trunk total displacement decreased during saccades compared to fixation; higher sway mean frequency in anterior-posterior direction during saccades was observed. Body sway was reduced in wide compared to narrow stance during high frequency saccades. These results indicate that eye movement improves postural stabilization and this effect is stronger in combination of wide stance-high frequency gaze condition.

The interplay between posture control and memory for spatial locations

Three experiments examined interactions between posture control in upright stance and a concurrent location memory task. Healthy young participants stood upright and memorized the locations of dots presented on a computer screen. In the retrieval phase, they indicated whether arrows presented on the screen would pass through any of the memorized locations. Postural sway variability was measured either during the retention period or during retrieval. Relative to not performing the memory task, postural sway variability increased in the retention period when the eyes were closed, but remained unaffected when the eyes were open. During retrieval, postural sway variability was reduced relative to the no-memory-task condition. Results were interpreted in terms of dual-task costs associated with maintaining multiple frames of reference.

Postural responses to a suprapostural visual task among children with and without developmental coordination disorder

We sought to determine the effects of varying the perceptual demands of a suprapostural visual task on the postural activity of children with developmental coordination disorder (DCD), and typically developing children (TDC). Sixty-four (32 per group) children aged between 9 and 10 years participated. In a within-participants design, each child performed a signal detection task at two levels of difficulty, low (LD) and high difficulty (HD). During performance of the signal detection tasks we recorded positional variability of the head and torso using a magnetic tracking system. We found that task difficulty had a greater effect on task performance among the TDC group than among children with DCD. Overall positional variability was greater the DCD group than in the TDC group. In the TDC group, positional variability was reduced during performance of the HD task, relative to sway during performance of the LD task. In the DCD group, positional variability was greater during performance of the HD task than during performance of the LD task. In children, DCD may reduce the strength of functional integration of postural activity with the demands of suprapostural visual tasks.