Quiet standing: The Single Inverted Pendulum model is not so bad after all

Delayed reinforcement learning converges to intermittent control for human quiet stance

The neural control of human quiet stance remains controversial, with classic views suggesting a limited role of the brain and recent findings conversely indicating direct cortical control of muscles during upright posture. Conceptual neural feedback control models have been proposed and tested against experimental evidence. The most renowned model is the continuous impedance control model. However, when time delays are included in this model to simulate neural transmission, the continuous controller becomes unstable. Another model, the intermittent control model, assumes that the central nervous system (CNS) activates muscles intermittently, and not continuously, to counteract gravitational torque. In this study, a delayed reinforcement learning algorithm was developed to seek optimal control policy to balance a one-segment inverted pendulum model representing the human body. According to this approach, there was no a-priori strategy imposed on the controller but rather the optimal strategy emerged from the reward-based learning. The simulation results indicated that the optimal neural controller exhibits intermittent, and not continuous, characteristics, in agreement with the possibility that the CNS intermittently provides neural feedback torque to maintain an upright posture.

How the brain can be trained to achieve an intermittent control strategy for stabilizing quiet stance by means of reinforcement learning

The stabilization of human quiet stance is achieved by a combination of the intrinsic elastic properties of ankle muscles and an active closed-loop activation of the ankle muscles, driven by the delayed feedback of the ongoing sway angle and the corresponding angular velocity in a way of a delayed proportional (P) and derivative (D) feedback controller. It has been shown that the active component of the stabilization process is likely to operate in an intermittent manner rather than as a continuous controller: the switching policy is defined in the phase-plane, which is divided in dangerous and safe regions, separated by appropriate switching boundaries. When the state enters a dangerous region, the delayed PD control is activated, and it is switched off when it enters a safe region, leaving the system to evolve freely. In comparison with continuous feedback control, the intermittent mechanism is more robust and capable to better reproduce postural sway patterns in healthy people. However, the superior performance of the intermittent control paradigm as well as its biological plausibility, suggested by experimental evidence of the intermittent activation of the ankle muscles, leaves open the quest of a feasible learning process, by which the brain can identify the appropriate state-dependent switching policy and tune accordingly the P and D parameters. In this work, it is shown how such a goal can be achieved with a reinforcement motor learning paradigm, building upon the evidence that, in general, the basal ganglia are known to play a central role in reinforcement learning for action selection and, in particular, were found to be specifically involved in postural stabilization.

Frequency analysis of ankle joint quasi-stiffness during quiet unperturbed standing in Chiari Malformation

Chiari Malformation (Chiari) is a congenital condition occurring from an inferior herniation of the cerebellar tonsils into the foramen magnum. Given the role of the cerebellum in postural control, it is reasonable to expect joint motion to be affected in this patient population. In fact, joint stiffness is a common self-reported symptom of Chiari, however it has never been assessed in these individuals. This study aimed to examine if ankle joint quasi-stiffness is correlated with Chiari severity. The human body was considered as an inverted oscillating pendulum without damping. A Fast Fourier Transform was used to extract natural frequency from the center of pressure trajectories during upright standing. Ankle joint quasi-stiffness was then calculated using the relationship between natural frequency and moment of inertia. Twelve Chiari participants (Chiari), six with decompression surgery (Chiari-D) and six without (Chiari-ND), and eight control individuals (Control) participated. Participants completed three, 30-second quiet standing trials on a force plate, focused on a target three meters in front of them. Chiari, regardless of surgery, had significantly lower quasi-stiffness than controls (Chiari-D vs. Control p = 0.0011, Chiari-ND vs. Control, p < 0.001). The proposed method is advantageous as it incorporates the entire center of pressure signal, minimizes error from instantaneous muscular dynamics, and does not require motion capture.

Age-related changes in static balance in older women aged in their early sixties to their late eighties: different aging patterns in the anterior-posterior and mediolateral directions

Objective

The aim of this study was to cross-sectionally investigate how static balance changes throughout the aging process in older women aged from their early sixties to their late eighties.

Methods

Forty-six older women (aged 62-89 years) were requested to stand barefoot and quietly on a force platform for 30 s with their eyes either open or closed. During the trials, the position of the center of foot pressure (CoP) and the acceleration of the body's center of mass (ACC) were measured. The root mean square (RMS) of the CoP and ACC values was calculated to evaluate the amplitude of postural sway and the level of regulatory activity, respectively. The mean power frequency of the ACC was also calculated to represent the temporal characteristics of regulatory activity.

Results

In the anterior-posterior direction, there was no significant relationship between the RMS of CoP and the participants' age, whereas the RMS of ACC significantly increased with increasing age. In the mediolateral direction, however, the RMS of CoP significantly increased with increasing age, whereas the RMS of ACC did not change with age. The mean power frequency of ACC did not exhibit any age-related change in either the anterior-posterior or the mediolateral direction.

Conclusion

The results indicate that static balance in older women aged in their early sixties to their late eighties exhibits distinctly contrasting aging patterns between the anterior-posterior and mediolateral directions. To prevent falls in older women, it is necessary to elucidate the physiological mechanisms responsible for the increase in mediolateral sway that occurs throughout old age.

Simulating cardiac signals on 3D human models for photoplethysmography development

Introduction: Image-based heart rate estimation technology offers a contactless approach to healthcare monitoring that could improve the lives of millions of people. In order to comprehensively test or optimize image-based heart rate extraction methods, the dataset should contain a large number of factors such as body motion, lighting conditions, and physiological states. However, collecting high-quality datasets with complete parameters is a huge challenge. Methods: In this paper, we introduce a bionic human model based on a three-dimensional (3D) representation of the human body. By integrating synthetic cardiac signal and body involuntary motion into the 3D model, five well-known traditional and four deep learning iPPG (imaging photoplethysmography) extraction methods are used to test the rendered videos. Results: To compare with different situations in the real world, four common scenarios (stillness, expression/talking, light source changes, and physical activity) are created on each 3D human. The 3D human can be built with any appearance and different skin tones. A high degree of agreement is achieved between the signals extracted from videos with the synthetic human and videos with a real human-the performance advantages and disadvantages of the selected iPPG methods are consistent for both real and 3D humans. Discussion: This technology has the capability to generate synthetic humans within various scenarios, utilizing precisely controlled parameters and disturbances. Furthermore, it holds considerable potential for testing and optimizing image-based vital signs methods in challenging situations where real people with reliable ground truth measurements are difficult to obtain, such as in drone rescue.

Effects of free versus restricted arm movements on postural control in normal and modified sensory conditions in young and older adults

The purpose of this study was to explore the effects of arm movements on postural control when standing under different sensory conditions in healthy young and older adults. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and 15 older (mean ± SD age; 73.3 ± 5.0 years) adults completed the modified Romberg test, which uses four task manipulations (i.e. eyes open and eyes closed on a firm and foam surface) to compromise the fidelity of sensory feedback mechanisms. Each participant completed the tasks under two arm movement conditions: restricted and free arm movements. Centre of pressure (COP) range and frequency were calculated to characterise postural performance and strategy, respectively. Older adults showed greater COP range with restricted compared to free arm movements during all modified sensory conditions, with these effects most prominent in the medio-lateral (ML) plane (all p < .05, Cohen's d = 0.69-1.61). Compared to the free arm movement condition, there was an increase in ML displacement and frequency when arm movements were restricted during only the most challenging (i.e. vestibular dominant) task in young adults (all p < .05, d = 0.645-0.83). Finally, main age effects for the arm restriction cost (p < .05) indicates a greater reliance on an upper body strategy in older compared to young adults, independent of sensory availability/accuracy. These findings indicate that older adults compensate for the loss of accuracy in sensory input by increasing reliance on upper body movement strategies.

Thinking on your feet: Anticipatory foot placements in repeated bimanual object displacements

Effective handling of objects requires proper use of the hands. If the object handling is done while standing or walking, it also requires proper use of the feet. We asked how people position their feet to meet future and ongoing object-handling demands. In previous research on this topic, participants walked to a table and picked up an object for a single displacement from one place to another. These studies shed light on sensitivity to kinematics but, strictly speaking, may not have revealed anything about sensitivity to dynamics. In the present study, we asked participants to walk to a table to move an object back and forth over different distances and at different rates. Prior to walking to the table, participants had full knowledge of what the task would be. By using a rhythmic rather than discrete object placement task, we could analyze participants' sensitivity to dynamics as well as kinematics. Consistent with our expectation that participants would tune their foot separations to demands related to dynamics, we found that stance width was wider for long than for short object displacements and was more pronounced for high displacement rates than for low displacement rates. Also consistent with our expectations about planning, these effects were evident as soon as participants reached the table. Our results add to the limited research on coordinated action of the hands and feet in purposeful object manipulation.

The effect of sleep deprivation on postural stability among physically active young adults

The study aimed to evaluate the effect of sleep deprivation on postural stability among physically active young adults. The study involved 22 physical education students. Average velocities and spatial distribution of the center of pressure displacements were taken as indicators of postural stability (double and one-leg standing). Two-way ANOVA with two factors of repeated measurements-"session" (control-experimental) and "daytime" (evening-morning)-was used. For indicators of the spatial distribution of the center of pressure in double stance with eyes open and eyes closed, and for average velocities for measurements with eyes closed, statistically significant interaction effects were found (at least p < 0.01, ƞ2 > 0.36, power statistics > 0.90) with the general tendency of higher results in the morning in the session with sleep deprivation than in the control session. In one-leg standing, an increase of average velocities was observed in the control session, and no differences in the session with sleep deprivation (interaction effect: at least p < 0.01, ƞ2 > 0.37, power statistics > 0.90). Besides spatial distribution indicators in double stance, there were no statistical differences between evening-morning tests in the session with sleep deprivation. Despite significant interaction effects, only the results of spatial distribution indicators in double stance were higher in the morning than in the evening in the session with sleep deprivation. So, no clear decline in postural stability after sleep deprivation was observed. This may suggest that sleep deprivation prevents natural regeneration rather than significantly worsening postural stability among physically active adults. It's possible that systematic physical activity might be one of the factors decreasing the risk of accidents among people exposed to sleep deprivation.

Assessing the influence of cognitive response conflict on balance control: an event-related approach using response-aligned force-plate time series data

Process interference or sharing of attentional resources between cognitive tasks and balance control during upright standing has been well documented. Attentional costs increase with greater balancing demands of a balance activity, for example in standing compared to sitting. The traditional approach for analyzing balance control using posturography with a force plate integrates across relative long trial periods of up to several minutes, which blends any balance adjustments and cognitive operations within this period. In the present study, we pursued an event-related approach to assess if single cognitive operations resolving response selection conflict in the Simon task interfere with concurrent balance control in quiet standing. In addition to traditional outcome measures (response latency, error proportions) in the cognitive Simon task, we investigated the effect of spatial congruency on measures of sway control. We expected that conflict resolution in incongruent trials would alter short-term progression of sway control. Our results demonstrated the expected congruency effect on performance in the cognitive Simon task and the mediolateral variability of balance control within 150 ms before the onset of the manual response was reduced to a greater degree in incongruent compared to congruent trials. In addition, mediolateral variability before and after the manual response was generally reduced compared to variability following target presentation, where no effect of congruency was observed. Assuming that response conflict in incongruent conditions requires suppression of the incorrect response tendencies, our results may imply that mechanisms of cognitive conflict resolution may also carry over to intermittent balance control mechanisms in a direction-specific manner.

The experimental multi-arm pendulum on a cart: A benchmark system for chaos, learning, and control

The single, double, and triple pendulum has served as an illustrative experimental benchmark system for scientists to study dynamical behavior for more than four centuries. The pendulum system exhibits a wide range of interesting behaviors, from simple harmonic motion in the single pendulum to chaotic dynamics in multi-arm pendulums. Under forcing, even the single pendulum may exhibit chaos, providing a simple example of a damped-driven system. All multi-armed pendulums are characterized by the existence of index-one saddle points, which mediate the transport of trajectories in the system, providing a simple mechanical analog of various complex transport phenomena, from biolocomotion to transport within the solar system. Further, pendulum systems have long been used to design and test both linear and nonlinear control strategies, with the addition of more arms making the problem more challenging. In this work, we provide extensive designs for the construction and operation of a high-performance, multi-link pendulum on a cart system. Although many experimental setups have been built to study the behavior of pendulum systems, such an extensive documentation on the design, construction, and operation is missing from the literature. The resulting experimental system is highly flexible, enabling a wide range of benchmark problems in dynamical systems modeling, system identification and learning, and control. To promote reproducible research, we have made our entire system open-source, including 3D CAD drawings, basic tutorial code, and data. Moreover, we discuss the possibility of extending our system capability to be operated remotely, enabling researchers all around the world to use it, thus increasing access.

Center of Pressure Behavior in Response to Unexpected Base of Support Shifting: A New Objective Tool for Dynamic Balance Assessment

The translation of the base of support represents a promising approach for the objective assessment of dynamic balance control. Therefore, this study aimed to present a servo-controlled, electrically driven movable plate and a new set of parameters based on the center-of-pressure (CoP) trajectory. Twenty subjects were assessed on a force platform screwed over a movable plate that could combine the following settings: direction (forward (FW) and backward (BW)), displacement (25 mm, 50 mm, and 100 mm), and ramp rate (100 mm/s and 200 mm/s). The subjects underwent two sets of 12 trials randomly combining the plate settings. From the CoP trajectory of the 2.5 s time window after the perturbation, the 95% confidence-interval ellipse (Area95) and the CoP mean velocity (Unit Path) were calculated. Within the same time window, the first peak (FP), the maximal oscillations (ΔCoPMax), and the standard deviation (PPV) of the CoP anterior-posterior trajectory were calculated. The plate direction (p < 0.01), ramp rate (p < 0.001), and displacement (p < 0.01) affected the Area95, FP, and ΔCoPMax, while the Unit Path and PPV were influenced only by the ramp rate (p < 0.001) and displacement (p < 0.001). The servo-controlled, electrically driven movable plate and the CoP-related parameters presented in this study represent a new promising objective tool for dynamic balance assessment.

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.

Exploring how arm movement moderates the effect of task difficulty on balance performance in young and older adults

Emerging evidence highlights that arm movements exert a substantial and functionally relevant contribution on quiet standing balance control in young adults. Ageing is associated with "non-functional" compensatory postural control strategies (i.e., lower limb co-contraction), which in turn, may increase the reliance on an upper body strategy to control upright stance. Thus, the primary purpose of this study was to compare the effects of free versus restricted arm movements on balance performance in young and older adults, during tasks of different difficulty. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and fifteen older (mean ± SD age; 73.3 ± 5.0 years) adults performed bipedal, semi-tandem and tandem balance tasks under two arm position conditions: restricted arm movements and free arm movements. Centre of pressure (COP) amplitude and frequency were calculated as indices of postural performance and strategy, respectively. Especially in older adults, restriction of arm movement resulted in increased sway amplitude and frequency, which was primarily observed for the mediolateral direction. Further, increasing balance task difficulty raised the arm restriction cost (ARC; a new measure to quantify free vs. restricted arm movement differences in postural control) that was more prominent in older adults. These findings indicate the ARC provides a measure of reliance on the upper body for balance control and that arm movement is important for postural control in older adults, especially during tasks of greater difficulty.

Auditory, tactile, and multimodal noise reduce balance variability

Auditory and somatosensory white noise can stabilize standing balance. However, the differential effects of auditory and tactile noise stimulation on balance are unknown. Prior work on unimodal noise stimulation showed gains in balance with white noise through the auditory and tactile modalities separately. The current study aims to examine whether multimodal noise elicits similar responses to unimodal noise. We recorded the postural sway of healthy young adults who were presented with continuous white noise through the auditory or tactile modalities and through a combination of both (multimodal condition) using a wearable device. Our results replicate previous work that showed that auditory or tactile noise reduces sway variability with and without vision. Additionally, we show that multimodal noise also reduces the variability of sway. Analysis of different frequency bands of sway is typically used to separate open-loop exploratory (< 0.3 Hz) and feedback-driven (> 0.3 Hz) sway. We performed this analysis and showed that unimodal and multimodal white noise affected postural sway variability similarly in both timescales. These results support that the sensory noise effects on balance are robust across unimodal and multimodal conditions and can affect both mechanisms of sway represented in the frequency spectrum. In future work, the parameters of acoustic/tactile manipulation should be optimized for the most effective balance stabilization, and multimodal therapies should be explored for older adults with typical age-related balance instabilities.

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.

Optimal controllers resembling postural sway during upright stance

The human postural control system can maintain our balance in an upright stance. A simplified control model that can mimic the mechanisms of this complex system and adapt to the changes due to aging and injuries is a significant problem that can be used in clinical applications. While the Intermittent Proportional Derivative (IPD) is commonly used as a postural sway model in the upright stance, it does not consider the predictability and adaptability behavior of the human postural control system and the physical limitations of the human musculoskeletal system. In this article, we studied the methods based on optimization algorithms that can mimic the performance of the postural sway controller in the upright stance. First, we compared three optimal methods (Model Predictive Control (MPC), COP-Based Controller (COP-BC) and Momentum-Based Controller (MBC)) in simulation by considering a feedback structure of the dynamic of the skeletal body as a double link inverted pendulum while taking into account sensory noise and neurological time delay. Second, we evaluated the validity of these methods by the postural sway data of ten subjects in quiet stance trials. The results revealed that the optimal methods could mimic the postural sway with higher accuracy and less energy consumption in the joints compared to the IPD method. Among optimal approaches, COP-BC and MPC show promising results to mimic the human postural sway. The choice of controller weights and parameters is a trade-off between the consumption of energy in the joints and the prediction accuracy. Therefore, the capability and (dis)advantage of each method reviewed in this article can navigate the usage of each controller in different applications of postural sway, from clinical assessments to robotic applications.

Integrating ankle and hip strategies for the stabilization of upright standing: An intermittent control model

Even in unperturbed upright standing of healthy young adults, body sway involves concurrent oscillations of ankle and hip joints, thus suggesting to using biomechanical models with at least two degrees of freedom, namely, a double inverted pendulum (DIP) framework. However, in a previous study, it was demonstrated that the observed coordinated ankle-hip patterns do not necessarily require the independent active control of the two joints but can be explained by a simpler hybrid control system, with a single active component (intermittent, delayed sensory feedback of the ongoing sway) applied to the ankle joint and a passive component (stiffness control) applied to the hip joint. In particular, the proposed active component was based on the internal representation of a virtual inverted pendulum (VIP) that links the ankle to the current position of the global center of mass (CoM). This hybrid control system, which can also be described as an ankle strategy, is consistent with the known kinematics of the DIP and, in particular, with the anti-phase correlation of the acceleration profiles of the two joints. The purpose of this study is to extend the hybrid control model in order to apply to both the ankle and hip strategy, clarifying as well the rationale of mixed strategies. The extension consists of applying the hybrid control scheme to both joints: a passive stiffness component and an active intermittent component, based on the same feedback signals derived from the common VIP but with independent parameter gains for the two joints. Thus, the hip gains are null in the pure ankle strategy, the ankle gains are null in the pure hip strategy, and both ankle and hip gains are specifically tuned in mixed strategies. The simulation of such an extended model shows that it can reproduce both strategies; moreover, the pure ankle strategy is more robust than the hip strategy, because the range of variation (RoV) of the intermittent control gains is larger in the former case than in the latter, and the pure ankle strategy is also more energy efficient. Generally, the simulations suggest that there is no advantage to employ mixed strategies, except in borderline situations in which the control gains are just outside the RoV that provides stable control for either pure strategy: in this case, a stable mixed strategy can emerge from the combination of two marginally unstable pure strategies.

The impact of external and internal focus of attention on visual dependence and EEG alpha oscillations during postural control

Background

The ability to maintain upright posture requires successful integration of multiple sensory inputs (visual, vestibular, and somatosensory). When one or more sensory systems become unreliable, the postural control system must “down-weight” (or reduce the influence of) those senses and rely on other senses to maintain postural stability. As individuals age, their ability to successfully reweight sensory inputs diminishes, leading to increased fall risk. The present study investigates whether manipulating attentional focus can improve the ability to prioritize different sensory inputs for postural control.

Methods

Forty-two healthy adults stood on a balance board while wearing a virtual reality (VR) head-mounted display. The VR environment created a multisensory conflict amongst the different sensory signals as participants were tasked with maintaining postural stability on the balance board. Postural sway and scalp electroencephalography (EEG) were measured to assess visual weighting and cortical activity changes. Participants were randomized into groups that received different instructions on where to focus their attention during the balance task.

Results

Following the instructions to direct attention toward the movement of the board (external focus group) was associated with lower visual weighting and better balance performance than when not given any instructions on attentional focus (control group). Following the instructions to direct attention towards movement of the feet (internal focus group) did not lead to any changes in visual weighting or balance performance. Both external and internal focus groups exhibited increased EEG alpha power (8–13 Hz) activity over the occipital cortex as compared to the control group.

Conclusions

Current results suggest that directing one’s attention externally, away from one’s body, may optimize sensory integration for postural control when visual inputs are incongruent with somatosensory and vestibular inputs. Current findings may be helpful for clinicians and researchers in developing strategies to improve sensorimotor mechanisms for balance.

Energy Cost of Dynamical Stabilization: Stored versus Dissipated Energy

Dynamical stabilization processes (homeostasis) are ubiquitous in nature, but the needed energetic resources for their existence have not been studied systematically. Here, we undertake such a study using the famous model of Kapitza’s pendulum, which has attracted attention in the context of classical and quantum control. This model is generalized and rendered autonomous, and we show that friction and stored energy stabilize the upper (normally unstable) state of the pendulum. The upper state can be rendered asymptotically stable, yet it does not cost any constant dissipation of energy, and only a transient energy dissipation is needed. Asymptotic stability under a single perturbation does not imply stability with respect to multiple perturbations. For a range of pendulum–controller interactions, there is also a regime where constant energy dissipation is needed for stabilization. Several mechanisms are studied for the decay of dynamically stabilized states.

Human balance augmentation via a supernumerary robotic tail

Humans are intrinsically unstable in quiet stance from a rigid body system viewpoint; however, they maintain balance thanks to neuro-muscular sensory properties whilst still exhibiting postural sway characteristics. This work intro-duces a one-degree-of-freedom supernumerary tail for balance augmentation in the sagittal plane to negate anterior-posterior postural sway. Simulations showed that the tail could success-fully balance a human with impaired ankle stiffness and neural control. Insights into tail design and control were made; namely, to minimise muscular load the tail must have a significant component in the direction of the muscle, mounting location of the tail is significant in maximising inertial properties for balance augmentation and that adaptive control of the tail will be best suited for different loads held by a wearer.

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.

Neuromuscular Control Modelling of Human Perturbed Posture Through Piecewise Affine Autoregressive With Exogenous Input Models

In this study, the neuromuscular control modeling of the perturbed human upright stance is assessed through piecewise affine autoregressive with exogenous input (PWARX) models. Ten healthy subjects underwent an experimental protocol where visual deprivation and cognitive load are applied to evaluate whether PWARX can be used for modeling the role of the central nervous system (CNS) in balance maintenance in different conditions. Balance maintenance is modeled as a single-link inverted pendulum; and kinematic, dynamic, and electromyography (EMG) data are used to fit the PWARX models of the CNS activity. Models are trained on 70% and tested on the 30% of unseen data belonging to the remaining dataset. The models are able to capture which factors the CNS is subjected to, showing a fitting accuracy higher than 90% for each experimental condition. The models present a switch between two different control dynamics, coherent with the physiological response to a sudden balance perturbation and mirrored by the data-driven lag selection for data time series. The outcomes of this study indicate that hybrid postural control policies, yet investigated for unperturbed stance, could be an appropriate motor control paradigm when balance maintenance undergoes external disruption.

Center of pressure plausibility for the double-link human stance model under the intermittent control paradigm

Despite human balance maintenance in quiet conditions could seem a trivial motor task, it is not. Recently, the human stance was described through a double link inverted pendulum (DIP) actively controlled at the ankle with an intermittent proportional (P) and derivative (D) control actions based on the sway of a virtual inverted pendulum (VIP) that links the ankle joint with the DIP center of mass. Such description, encompassing both the mechanical model and the intermittent control policy, was referred as the DIP/VIP human stance model, and it showed physiologically plausible kinematic patterns. In this study a mathematical formalization of the Center of pressure (COP) for a DIP structure was developed. Then, it was used in conjunction with an intermittently controlled DIP/VIP model to assess its kinetic plausibility. Three descriptors commonly employed in posturography were selected among six based on their capability to discriminate between young (Y) and elderly (O) adults groups. Then, they were applied to assess whether variations of the P-D parameters affect the synthetic COP. The results showed that DIP/VIP model can reproduce COP trajectories, showing characteristics similar to the Y and O groups. Moreover, it was observed that both P and D parameters increased passing from Y to O, indicating that the COP obtained from the DIP/VIP model is able to highlight differences in balance control between groups. The study hence promote the use of DIP/VIP in posturography, where inferential techniques can be applied to characterize neural control.

Frequency-dependent force direction elucidates neural control of balance

Background

Maintaining upright posture is an unstable task that requires sophisticated neuro-muscular control. Humans use foot–ground interaction forces, characterized by point of application, magnitude, and direction to manage body accelerations. When analyzing the directions of the ground reaction forces of standing humans in the frequency domain, previous work found a consistent pattern in different frequency bands. To test whether this frequency-dependent behavior provided a distinctive signature of neural control or was a necessary consequence of biomechanics, this study simulated quiet standing and compared the results with human subject data.

Methods

Aiming to develop the simplest competent and neuromechanically justifiable dynamic model that could account for the pattern observed across multiple subjects, we first explored the minimum number of degrees of freedom required for the model. Then, we applied a well-established optimal control method that was parameterized to maximize physiologically-relevant insight to stabilize the balancing model.

Results

If a standing human was modeled as a single inverted pendulum, no controller could reproduce the experimentally observed pattern. The simplest competent model that approximated a standing human was a double inverted pendulum with torque-actuated ankle and hip joints. A range of controller parameters could stabilize this model and reproduce the general trend observed in experimental data; this result seems to indicate a biomechanical constraint and not a consequence of control. However, details of the frequency-dependent pattern varied substantially across tested control parameter values. The set of parameters that best reproduced the human experimental results suggests that the control strategy employed by human subjects to maintain quiet standing was best described by minimal control effort with an emphasis on ankle torque.

Conclusions

The findings suggest that the frequency-dependent pattern of ground reaction forces observed in quiet standing conveys quantitative information about human control strategies. This study’s method might be extended to investigate human neural control strategies in different contexts of balance, such as with an assistive device or in neurologically impaired subjects.

Multisensory postural control in adults: Variation in visual, haptic, and proprioceptive inputs

Maintaining balance is fundamentally a multisensory process, with visual, haptic, and proprioceptive information all playing an important role in postural control. The current project examined the interaction between such sensory inputs, manipulating visual (presence versus absence), haptic (presence versus absence of contact with a stable or unstable finger support surface), and proprioceptive (varying stance widths, including shoulder width stance, Chaplin [heels together, feet splayed at approximately 60°] stance, feet together stance, and tandem stance) information. Analyses of mean velocity of the Centre of Pressure (CoP) revealed significant interactions between these factors, with stability gains observed as a function of increasing sensory information (e.g., visual, haptic, visual + haptic), although the nature of these gains was modulated by the proprioceptive information and the reliability of the haptic support surface (i.e., unstable versus stable finger supports). Subsequent analyses on individual difference parameters (e.g., height, leg length, weight, and areas of base of support) revealed that these variables were significantly related to postural measures across experimental conditions. These findings are discussed relative to their implications for multisensory postural control, and with respect to inverted pendulum models of balance. (185 words).

Are Static and Dynamic Postural Balance Assessments Two Sides of the Same Coin? A Cross-Sectional Study in the Older Adults

The aim of this study was to investigate if the combination of static and dynamic postural balance assessments gives more accurate indications on balance performance among healthy older adults. We also aimed at studying the effect of a dual-task condition on static and dynamic postural balance control. Fifty-seven healthy older adults (age = 73.2 ± 5.0 year, height = 1.66 ± 0.08 m, and body mass = 72.8 ± 13.8 kg) completed the study. Static and dynamic balance were assessed both in single-task and dual-task conditions through a force plate and an oscillating platform. The dominant handgrip strength was also measured with a dynamometer. Pearson’s correlation revealed non-statistically significant correlations between static and dynamic balance performance. The dual-task worsened the balance performance more in the dynamic (+147.8%) than in the static (+25.10%, +43.45%, and +72.93% for ellipse area, sway path, and AP oscillations, respectively) condition (p < 0.001). A weak correlation was found between dynamic balance performance and handgrip strength both in the single (p < 0.05; r = −0.264) and dual (p < 0.05; r = −0.302) task condition. The absence of correlations between static and dynamic balance performance suggests including both static and dynamic balance tests in the assessment of postural balance alterations among older adults. Since cognitive-interference tasks exacerbated the degradation of the postural control performance, dual-task condition should also be considered in the postural balance assessment.

Characterizing the Validity of the Inverted Pendulum Model for Quiet Standing

By assuming that the human body rotates primarily around the ankle joint in the sagittal plane, the human body has been modelled as a single inverted pendulum (IP) to simulate the human quiet stance. Despite its popularity, the validity of the IP model has been challenged in many studies. Rather than testing the validity of the IP model as a true or false question, this work proposes a feature to quantify the degree of validity of the IP model. The development of the proposed feature is based on the fact that the IP model predicts that the horizontal acceleration of COM is proportional to the COP error which is defined as the difference between the center of pressure (COP) and the vertical projection of the center of mass (COM). Since the horizontal components of the acceleration of COM and the ground reaction force (GRF) are always proportional, the proposed feature is the correlation coefficient between the anterior-posterior (AP) components of GRF and the COP error. The efficacy of the proposed feature is demonstrated by comparing its differences for individuals in two age groups (18–24 and 65–73 years) in quiet standing. The experimental results show that the IP model is more suited for predicting the motion of the older group than the younger group. Our results also show that the proposed feature is more sensitive to aging effects than one of the most reliable and accurate COP-based postural stability features.

Response to perturbation during quiet standing resembles delayed state feedback optimized for performance and robustness

Postural sway is a result of a complex action–reaction feedback mechanism generated by the interplay between the environment, the sensory perception, the neural system and the musculation. Postural oscillations are complex, possibly even chaotic. Therefore fitting deterministic models on measured time signals is ambiguous. Here we analyse the response to large enough perturbations during quiet standing such that the resulting responses can clearly be distinguished from the local postural sway. Measurements show that typical responses very closely resemble those of a critically damped oscillator. The recovery dynamics are modelled by an inverted pendulum subject to delayed state feedback and is described in the space of the control parameters. We hypothesize that the control gains are tuned such that (H1) the response is at the border of oscillatory and nonoscillatory motion similarly to the critically damped oscillator; (H2) the response is the fastest possible; (H3) the response is a result of a combined optimization of fast response and robustness to sensory perturbations. Parameter fitting shows that H1 and H3 are accepted while H2 is rejected. Thus, the responses of human postural balance to “large” perturbations matches a delayed feedback mechanism that is optimized for a combination of performance and robustness.

Long-Lasting Event-Related Beta Synchronizations of Electroencephalographic Activity in Response to Support-Surface Perturbations During Upright Stance: A Pilot Study Associating Beta Rebound and Active Monitoring in the Intermittent Postural Control

Movement related beta band cortical oscillations, including beta rebound after execution and/or suppression of movement, have drawn attention in upper extremity motor control literature. However, fewer studies focused on beta band oscillations during postural control in upright stance. In this preliminary study, we examined beta rebound and other components of electroencephalogram (EEG) activity during perturbed upright stance to investigate supraspinal contributions to postural stabilization. Particularly, we aimed to clarify the timing and duration of beta rebound within a non-sustained, but long-lasting postural recovery process that occurs more slowly compared to upper extremities. To this end, EEG signals were acquired from nine healthy young adults in response to a brief support-surface perturbation, together with the center of pressure, the center of mass and electromyogram (EMG) activities of ankle muscles. Event-related potentials (ERPs) and event-related spectral perturbations were computed from EEG data using the perturbation-onset as a triggering event. After short-latency (<0.3 s) ERPs, our results showed a decrease in high-beta band oscillations (event-related desynchronization), which was followed by a significant increase (event-related synchronization) in the same band, as well as a decrease in theta band oscillations. Unlike during upper extremity motor tasks, the beta rebound in this case was initiated before the postural recovery was completed, and sustained for as long as 3 s with small EMG responses for the first half period, followed by no excessive EMG activities for the second half period. We speculate that those novel characteristics of beta rebound might be caused by slow postural dynamics along a stable manifold of the unstable saddle-type upright equilibrium of the postural control system without active feedback control, but with active monitoring of the postural state, in the framework of the intermittent control.

Idiosyncratic Characteristics of Postural Sway in Normal and Perturbed Standing

Objective

Are people with a characteristically large physiological sway rendered particularly unstable when standing on a moving surface? Is postural sway in standing individuals idiosyncratic? In this study, we examine postural sway in individuals standing normally, and when subtle continuous sinusoidal disturbances are applied to their support platform. We calculate consistency between conditions to verify if sway can be considered characteristic of each individual. We also correlate two different aspects of participants’ responses to disturbance; their sway velocity and their regulation of body orientation.

Methods

Nineteen healthy adults (age 29.2 ± 3.2 years) stood freely on footplates coaxially aligned with their ankles and attached to a motorized platform. They had their eyes closed, and hips and knees locked with a light wooden board attached to their body. Participants either stood quietly on a fixed platform or on a slowly tilting platform (0.1 Hz sinusoid; 0.2 and 0.4 deg). Postural sway size was separated into two entities: (1) the spontaneous sway velocity component (natural random relatively rapid postural adjustments, RMS body angular velocity) and (2) the evoked tilt gain component (much slower 0.1 Hz synchronous tilt induced by the movement of the platform, measured as peak-to-peak (p-p) gain, ratio of body angle to applied footplate rotation).

Results

There was no correlation between the velocity of an individual’s sway and their evoked tilt gain (r = 0.34, p = 0.15 and r = 0.30, p = 0.22). However, when considered separately, each of the two measurements showed fair to good absolute agreement within conditions. Spontaneous sway velocity consistently increased as participants were subjected to increasing disturbance. Participants who swayed more (or less) did so across all conditions [ICC_(3,k) = 0.95]. Evoked tilt gain also showed consistency between conditions [ICC_(3,k) = 0.79], but decreased from least to most disturbed conditions.

Conclusion

The two measurements remain consistent between conditions. Consistency between conditions of two very distinct unrelated measurements reflects the idiosyncratic nature of postural sway. However, sway velocity and tilt gain are not related, which supports the idea that the short-term regulation of stability and the longer-term regulation of orientation are controlled by different processes.

Multi-segment phase coupling to oscillatory visual drive

BACKGROUND

It has been shown that humans adapt their postural sway to oscillatory, visually simulated self-motion. However, little is still known about the way individual body segments contribute to this adjustment of body sway and how this contribution varies with different environmental conditions.

RESEARCH QUESTION

How do the centre of pressure (COP) and individual body segments phase-lock to a sinusoidal visual drive depending on the frequency of stimulation?

METHODS

In this study, we introduce phase coupling as a method for assessing full body motion in response to visual stimuli presented in virtual reality (VR). 12 participants (mean age: 31 ± 9 years) stood inside a virtual tunnel which oscillated sinusoidally in the anterior-posterior direction at a frequency of 0.2 Hz, 0.8 Hz or 1.2 Hz. Primary outcome measures were the trajectories of their COP as well as of 25 body segments obtained by a motion tracking system.

RESULTS

Subjects significantly coupled the phase of their COP and body segments to the visual drive. Our analysis yielded significant phase coupling of the COP to the stimulus for all tested frequencies. The phase coupling of body segments revealed a shift in postural response as a function of frequency. At the low frequency of 0.2 Hz, we found strong and significant phase coupling homogeneously distributed across the body. At the higher frequencies of 0.8 Hz and 1.2 Hz, however, overall phase coupling became weaker and was centred around the lower torso and hip segments.

SIGNIFICANCE

Information on how the visual percept of self-motion affects balance control is crucial for understanding visuomotor processing in health and disease. Our setup and methods constitute a reliable tool for assessing perturbed balance control, which can be utilized in future clinical trials.

The assessment of center of mass and center of pressure during quiet stance: Current applications and future directions

This perspective article provides a brief review of our understanding of how center of pressure (CoP) and center of mass (CoM) are traditionally utilized to measure quiet standing and how technological advancements are allowing for measurements to be derived outside the confines of a laboratory setting. Furthermore, this viewpoint provides descriptions of what CoP and CoM outcomes may reflect, a discussion of recent developments in selected balance outcomes, the importance of measuring instantaneous balance outcomes, and directions for future questions/research. Considering the enormous number and cost of falls annually, conclusions drawn from this perspective underscore the need for more cohesive efforts to advance our understanding of balance performance. As we refine the technology and algorithms used to portably assess postural stability, the question of which measurement (i.e. CoP or CoM) to utilize seems to be highly dependent on the question being asked. Further, the complexity of the question appears to span multiple disciplines and cultivate exploration of the intrinsic mechanisms of stability. Recently developed multi-dimensional methods for assessing balance performance may provide additional insight into balance, improving our ability to predict balance impairments and falls outside the laboratory and in the clinic. However, additional work will be necessary to understand the clinical significance and predictive capacity of these outcomes in various fall-prone populations.

Development of a theoretical model for upright postural control in lower limb prosthesis users

Methods used to assess quiet standing in unilateral prosthesis users often assume validity of an inverted pendulum model despite this being shown as invalid in some instances. The aim of the current study was to evaluate the validity of a proposed unilaterally-constrained pin-controller model in explaining postural control in unilateral prosthesis users. Prosthesis users were contrasted against the theoretical model as were able-bodied controls that stood on a platform which unilaterally constrained movement of the CoP. All participants completed bouts of quiet standing with eyes open, eyes closed and with feedback on inter-limb weight bearing asymmetry. Correlation coefficients were used to infer inverted pendulum behavior in both the anteroposterior and mediolateral directions and were derived from both kinematic (body attached markers) and kinetic (centre of pressure) experimental data. Larger, negative correlation coefficients reflected better model adherence, whilst low or no correlation reflected poorer model adherence. Inverted pendulum behavior derived from kinematic data, indicated coefficients of high magnitude in both mediolateral (all cases range 0.71–0.78) and anteroposterior (0.88–0.91) directions, irrespective of groups. Inverted pendulum behavior derived from kinetic data in the anteroposterior direction indicated validity of the model with large negative coefficients associated with the unconstrained/intact limbs (prosthesis users: − 0.45 to − 0.65, control group: − 0.43 to − 0.72), small coefficients in constrained/prosthetic limbs (prosthesis users: − 0.02 to 0.07, control group: 0.13–0.26) and large negative coefficients in combined conditions (prosthesis users: − 0.36 to − 0.56, control group: − 0.71 to − 0.82). For the mediolateral direction, coefficients were negligible for individual limbs (0.03–0.17) and moderate to large negative correlations, irrespective of group (− 0.31 to − 0.73). Data suggested both prosthesis users’ and able-bodied individuals’ postural control conforms well to that predicted by a unilaterally-constrained pin-controller model, which has implications for the fundamental control of posture in transtibial prosthesis users.

Rolling balance board of adjustable geometry as a tool to assess balancing skill and to estimate reaction time delay

The relation between balancing performance and reaction time is investigated for human subjects balancing on rolling balance board of adjustable physical parameters: adjustable rolling radius R and adjustable board elevation h. A well-defined measure of balancing performance is whether a subject can or cannot balance on balance board with a given geometry (R, h). The balancing ability is linked to the stabilizability of the underlying two-degree-of-freedom mechanical model subject to a delayed proportional-derivative feedback control. Although different sensory perceptions involve different reaction times at different hierarchical feedback loops, their effect is modelled as a single lumped reaction time delay. Stabilizability is investigated in terms of the time delay in the mechanical model: if the delay is larger than a critical value (critical delay), then no stabilizing feedback control exists. Series of balancing trials by 15 human subjects show that it is more difficult to balance on balance board configuration associated with smaller critical delay, than on balance boards associated with larger critical delay. Experiments verify the feature of the mechanical model that a change in the rolling radius R results in larger change in the difficulty of the task than the same change in the board elevation h does. The rolling balance board characterized by the two well-defined parameters R and h can therefore be a useful device to assess human balancing skill and to estimate the corresponding lumped reaction time delay.

Effects of white Gaussian noise on dynamic balance in healthy young adults

It has been known that short-time auditory stimulation can contribute to the improvement of the balancing ability of the human body. The present study aims to explore the effects of white Gaussian noise (WGN) of different intensities and frequencies on dynamic balance performance in healthy young adults. A total of 20 healthy young participants were asked to stand at a dynamic balance force platform, which swung along the x-axis with an amplitude of ± 4° and frequency of 1 Hz. Their center of pressure (COP) trajectories were recorded when they were stimulated by WGN of different intensities (block 1) and different frequencies (block 2). A traditional method and detrended fluctuation analysis (DFA) were used for data preprocessing. The authors found that only with 75–85 dB WGN, the COP parameters improved. WGN frequency did not affect the dynamic balance performance of all the participants. The DFA results indicated stimulation with 75 dB WGN enhanced the short-term index and reduced the crossover point. Stimulation with 500 Hz and 2500 Hz WGN significantly enhanced the short-term index. These results suggest that 75 dB WGN and 500 Hz and 2500 Hz WGN improved the participants’ dynamic balance performance. The results of this study indicate that a certain intensity of WGN is indispensable to achieve a remarkable improvement in dynamic balance. The DFA results suggest that WGN only affected the short-term persistence, indicating the potential of WGN being considered as an adjuvant therapy in low-speed rehabilitation training.

Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach

Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.

Mal de Debarquement Syndrome: A Matter of Loops?

Introduction: Mal de Debarquement Syndrome (MdDS) is a poorly understood neurological disorder affecting mostly perimenopausal women. MdDS has been hypothesized to be a maladaptation of the vestibulo-ocular reflex, a neuroplasticity disorder, and a consequence of neurochemical imbalances and hormonal changes. Our hypothesis considers elements from these theories, but presents a novel approach based on the analysis of functional loops, according to Systems and Control Theory.

Hypothesis: MdDS is characterized by a persistent sensation of self-motion, usually occurring after sea travels. We assume the existence of a neuronal mechanism acting as an oscillator, i.e., an adaptive internal model, that may be able to cancel a sinusoidal disturbance of posture experienced aboard, due to wave motion. Thereafter, we identify this mechanism as a multi-loop neural network that spans between vestibular nuclei and the flocculonodular lobe of the cerebellum. We demonstrate that this loop system has a tendency to oscillate, which increases with increasing strength of neuronal connections. Therefore, we hypothesize that synaptic plasticity, specifically long-term potentiation, may play a role in making these oscillations poorly damped. Finally, we assume that the neuromodulator Calcitonin Gene-Related Peptide, which is modulated in perimenopausal women, exacerbates this process thus rendering the transition irreversible and consequently leading to MdDS.

Conclusion and Validation: The concept of an oscillator that becomes noxiously permanent can be used as a model for MdDS, given a high correlation between patients with MdDS and sea travels involving undulating passive motion, and an alleviation of symptoms when patients are re-exposed to similar passive motion. The mechanism could be further investigated utilizing posturography tests to evaluate if subjective perception of motion matches with objective postural instability. Neurochemical imbalances that would render individuals more susceptible to developing MdDS could be investigated through hormonal profile screening. Alterations in the connections between vestibular nuclei and cerebellum, notably GABAergic fibers, could be explored by neuroimaging techniques as well as transcranial magnetic stimulation. If our hypothesis were tested and verified, optimal targets for MdDS treatment could be found within both the neural networks and biochemical factors that are deemed to play a fundamental role in loop functioning and synaptic plasticity.

Postural instability via a loss of intermittent control in elderly and patients with Parkinson's disease: A model-based and data-driven approach

Postural instability is one of the major symptoms of Parkinson's disease. Here, we assimilated a model of intermittent delay feedback control during quiet standing into postural sway data from healthy young and elderly individuals as well as patients with Parkinson's disease to elucidate the possible mechanisms of instability. Specifically, we estimated the joint probability distribution of a set of parameters in the model using the Bayesian parameter inference such that the model with the inferred parameters can best-fit sway data for each individual. It was expected that the parameter values for three populations would distribute differently in the parameter space depending on their balance capability. Because the intermittent control model is parameterized by a parameter associated with the degree of intermittency in the control, it can represent not only the intermittent model but also the traditional continuous control model with no intermittency. We showed that the inferred parameter values for the three groups of individuals are classified into two major groups in the parameter space: one represents the intermittent control mostly for healthy people and patients with mild postural symptoms and the other the continuous control mostly for some elderly and patients with severe postural symptoms. The results of this study may be interpreted by postulating that increased postural instability in most Parkinson's patients and some elderly persons might be characterized as a dynamical disease.

Optimal time-varying postural control in a single-link neuromechanical model with feedback latencies

Maintaining balance during quiet standing is a challenging task for the neural control mechanisms due to the inherent instabilities involved in the task. The feedback latencies and the lowpass characteristics of skeletal muscle add to the difficulty of regulating postural dynamics in real-time. Inverted-pendulum (IP) type robotic models have served as a popular paradigm to investigate control of postural balance. In this study, an in-depth neuromechanical postural control model is developed from physiological principles. The model comprises a single-segment IP robotic model, Hill-type muscle model, and proprioceptive feedback from the muscle spindle (MS) and golgi tendon organ (GTO). An optimal proportional-integral-derivative (PID) controller is proposed to realize effective postural control amid latencies in sensory feedback. The neural commands for postural stabilization are generated by a time-varying PID controller, tuned using linear quadratic regulator (LQR) principles. Computer simulations are used to assess the efficacy of the tuned PID-LQR controller. Sensitivity analysis of the controlled system shows a delay tolerance of 300ms. Preliminary empirical data in support of the mathematical model were obtained from perturbation experiments. The model response to perturbation torque, measured in terms of the center of mass (COM) excursion in the anterior-posterior (AP) direction, displays a high degree of correlation with the empirical data ([Formula: see text]).

Centre of pressure versus centre of mass stabilization strategies: the tightrope balancing case

This study proposes a generalization of the ankle and hip postural strategies to be applied to the large class of skills that share the same basic challenge of defeating the destabilizing effect of gravity on the basis of the same neuromotor control organization, adapted and specialized to a variable number of degrees of freedom, different body parts, different muscles and different sensory feedback channels. In all the cases, we can identify two crucial elements (the CoP, centre of pressure and the CoM, centre of mass) and the central point of the paper is that most balancing skills can be framed in the CoP-CoM interplay and can be modelled as a combination/alternation of two basic stabilization strategies: the standard well-investigated COPS (or CoP stabilization strategy, the default option), where the CoM is the controlled variable and the CoP is the control variable, and the less investigated COMS (or CoM stabilization strategy), where CoP and CoM must exchange their role because the range of motion of the CoP is strongly constrained by environmental conditions. The paper focuses on the tightrope balancing skill where sway control in the sagittal plane is modelled in terms of the COPS while the more challenging sway in the coronal plane is modelled in terms of the COMS, with the support of a suitable balance pole. Both stabilization strategies are implemented as state-space intermittent, delayed feedback controllers, independent of each other. Extensive simulations support the degree of plausibility, generality and robustness of the proposed approach.

Modeling the neuro-mechanics of human balance when recovering from a fall: a continuous-time approach

BACKGROUND

Balance control deteriorates with age and nearly 30% of the elderly population in the United States reports stability problems. Postural stability is an integral task to daily living reliant upon the control of the ankle and hip. To this end, the estimation of joint parameters can be a useful tool when analyzing compensatory actions aimed at maintaining postural stability.

METHODS

Using an analytical approach, this study expands on previous work and analyzes a two degrees of freedom human model. The first two modes of vibration of the system are represented by the neuro-mechanical parameters of a second-order, time-varying Kelvin-Voigt model actuated at the ankle and hip. The model is tested using a custom double inverted pendulum and healthy volunteers who were subjected to a positional step-like perturbation during quiet standing. An in silico sensitivity analysis of the influence of inertial parameters was also performed.

RESULTS

The proposed method is able to correctly identify the time-varying visco-elastic parameters of of a double inverted pendulum. We show that that the parameter estimation method can be applied to standing humans. These results appear to identify a subject-independent strategy to control quiet standing that combines both the modulation of stiffness, and the use of an intermittent control.

CONCLUSIONS

This paper presents the analysis of the non-linear system of differential equations representing the control of lumped muscle-tendon units. It utilizes motion capture measurements to obtain the estimates of the system's control parameters by constructing a simple time-dependent regressor for estimating the time-varying parameters of the control with a single perturbation. This work is a step forward into the understanding of the neuro-mechanical control parameters of human recovering from a fall. In previous literature, the analysis is either restricted to the first vibrational mode of an inverted-pendulum model or assumed to be time-invariant. The proposed method allows for the analysis of hip related movement for stability control and highlights the importance of core training.

Quantifying Postural Control in Premanifest and Manifest Huntington Disease Using Wearable Sensors

Background. Impairments in postural control in Huntington disease (HD) have important consequences for daily functioning. This observational study systematically examined baseline postural control and the effect of sensory attenuation and sensory enhancement on postural control across the spectrum of HD. Methods. Participants (n = 39) included healthy controls and individuals in premanifest (pHD) and manifest stages (mHD) of HD. Using wearable sensors, postural control was assessed according to (1) postural set (sit vs stand), (2) sensory attenuation using clinical test of sensory integration, and (3) sensory enhancement with gaze fixation. Outcomes included sway smoothness, amplitude, and frequency. Results. Based on postural set, pHD reduced postural sway in sitting relative to standing, whereas mHD had pronounced sway in standing and sitting, highlighting a baseline postural deficit. During sensory attenuation, postural control in pHD deteriorated relative to controls when proprioceptive demands were high (eyes closed on foam), whereas mHD had significant deterioration of postural control when proprioception was attenuated (eyes open and closed on foam). Finally, gaze fixation improved sway smoothness, amplitude, and frequency in pHD; however, no benefit was observed in mHD. Conclusions. Systematic examination of postural control revealed a fundamental postural deficit in mHD, which further deteriorates when proprioception is challenged. Meanwhile, postural deficits in pHD are detectable when proprioceptive challenge is high. Sensory enhancing strategies using gaze fixation to benefit posture may be useful when introduced well before motor diagnosis. These findings encourage further examination of wearable sensors as part of routine clinical assessments in HD.

State-space intermittent feedback stabilization of a dual balancing task

Balancing the body in upright standing and balancing a stick on the fingertip are two examples of unstable tasks that, in spite of strong motor and sensory differences, appear to share a similar motor control paradigm, namely a state-space intermittent feedback stabilization mechanism. In this study subjects were required to perform the two tasks simultaneously, with the purpose of highlighting both the coordination between the two skills and the underlying interaction between the corresponding controllers. The experimental results reveal, in particular, that upright standing (the less critical task) is modified in an adaptive way, in order to facilitate the more critical task (stick balancing), but keeping the overall spatio-temporal signature well known in regular upright standing. We were then faced with the following question: to which extent the physical/biomechanical interaction between the two independent intermittent controllers is capable to explain the dual task coordination patterns, without the need to introduce an additional, supervisory layer/module? By comparing the experimental data with the output of a simulation study we support the former hypothesis, suggesting that it is made possible by the intrinsic robustness of both state-space intermittent feedback stabilization mechanisms.

The Influence of Posture, Applied Force and Perturbation Direction on Hip Joint Viscoelasticity

Limb viscoelasticity is a critical neuromechanical factor used to regulate the interaction with the environment. It plays a key role in modelling human sensorimotor control, and can be used to assess the condition of healthy and neurologically affected individuals. This paper reports the estimation of hip joint viscoelasticity during voluntary force control using a novel device that applies a leg displacement without constraining the hip joint. The influence of hip angle, applied limb force and perturbation direction on the stiffness and viscosity values was studied in ten subjects. No difference was detected in the hip joint stiffness between the dominant and non-dominant legs, but a small dependency was observed on the perturbation direction. Both hip stiffness and viscosity increased monotonically with the applied force magnitude, with posture being observed to have a slight influence. These results are in line with previous measurements carried out on upper limbs, and can be used as a baseline for lower limb movement simulation and further neuromechanical investigations.

Force accuracy rather than high stiffness is associated with faster learning and reduced falls in human balance

Balance requires the centre of mass to be maintained within the base of support. This can be achieved by minimising position sway (stiffness control: SC) or minimising force error (force accuracy control: FAC). Minimising sway reduces exploration of system properties, whereas minimising force error maximizes accurate mapping of the force vs position. We hypothesise that (i) FAC is associated with faster learning and fewer falls whereas (ii) SC is not. Fifteen participants used myoelectric signals from their legs to maintain balance of an actuated, inverted pendulum, to which they were strapped. Using challenging perturbations, participants were trained to maintain balance without falling within five sessions and tested before (PRE) and after (POST) training. We quantified FAC as 'change (POST-PRE) in correlation of force with position' and SC as 'change in sway'. PRE training, five measures (sway, acceleration, co-contraction, effort, falls) showed no correlation with either FAC or SC. POST training, reduced fall rate, effort and acceleration correlated with FAC metric. SC correlated only with reduced sway. Unlike sway minimisation, development of force accuracy was associated with learning and reduced falls. These results support that accurate force estimation allowing movement is more relevant than stiffness to improve balance and prevent falls.