Effect of strength training with additional acupuncture on balance, ankle sensation, and isokinetic muscle strength in chronic ankle instability among college students

Purpose: The effects of the combination of strength training and acupuncture on chronic ankle instability have not been studied. This study examined effects of strength training combined with acupuncture on balance ability, ankle motion perception, and muscle strength in chronic ankle instability among college students. Methods: Forty-six chronic ankle instability college students were randomly categorized into the experimental group (n = 24, strength training + acupuncture) and the control group (n = 22, strength training) for an 8-week intervention. Results: For the results at 8 weeks, compared with the baseline, in the experimental group, the chronic Ankle Instability Tool (CAIT) score, ankle dorsiflexion, plantar flex, eversion peak torque (60°/s), and plantar flex peak torque (180°/s) increased by 13.7%, 39.4%, 13.7%, 14.2%, and 12.3%, respectively. Dorsiflexion, plantar flexion, inversion, and eversion kinesthetic sensation test angles decreased by 17.4%, 20.6%, 15.0%, and 17.2%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. In the control group, the Cumberland Ankle Instability Tool score and the ankle dorsiflexion peak torque (60°/s) increased by 13.8% and 17.9%, respectively. The inversion kinesthetic sensation test angle decreased by 15.2%, whereas anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 17.1%, 29.4%, 12.3%, and 16.8%, respectively. 2) For the comparison between the groups after 8 weeks, the values of ankle dorsiflexion and plantar flex peak torque (60°/s) in the experimental group were greater than those in the control group. The values of ankle plantar flex kinesthetic sensation test angle, the anterior-posterior displacement, and anterior-posterior mean velocity in the experimental group were lower than those in the control group. Conclusion: Acupuncture treatment in conjunction with muscle strength training can further improve the balance ability of anterior-posterior, ankle dorsiflexion, and plantar flex strength and plantar flex motion perception in chronic ankle instability participants.

Influence of strength and balance ability on functional performance in the involved and uninvolved sides after anterior cruciate ligament reconstruction

BACKGROUND

The restoration and management of the uninvolved side have been emphasized to prevent a second anterior cruciate ligament (ACL) injury and to ensure that athletes return to sports after ACL reconstruction.

OBJECTIVE

To determine the factors influencing the single leg hop test (SLHT) and single leg vertical jump test (SLVJT) at 1 year postoperatively after ACL reconstruction in both the involved and uninvolved sides.

METHODS

Ninety-four patients who underwent ACL reconstruction were assessed at 1 year postoperatively. Multiple regression models included eight independent variables with two dependent variables (SLHT and SLVJT.), each on the involved and uninvolved side.

RESULTS

On the involved side, the Y balance test (YBT), extensor peak torque per body weight (PT/BW), Biodex balance system anteroposterior index (BBS-API), and sex accounted for 53.9% of the variance in SLHT (P= 0.002), and extensor PT/BW and YBT accounted for 26.3% of the variance in SLVJT (P= 0.027). On the uninvolved side, YBT, sex, age, BBS-API, and flexor PT/BW accounted for 47.0% of the variance in SLHT (P= 0.046), and flexor PT/BW, YBT, and age accounted for 44.9% of the variance in SLVJT (P= 0.002).

CONCLUSION

Knee extensor strength on the involved side and flexor strength on the uninvolved side influence the two functional performance tests. The YBT was an important factor in the two functional performance tests in both sides. Anteroposterior stability was the only factor that influenced the SLHT bilaterally.

Do visual and step height factors cause imbalance during bipedal and unipedal stances? A plantar pressure perspective

Objective: The plantar pressure analysis technique was used to explore the static balance ability and stability of healthy adult males under the influence of visual and step height factors during bipedal and unipedal stances. Methods: Thirty healthy adult males volunteered for the study. Experiments used the F-scan plantar pressure analysis insoles to carry out with eyes open (EO) and eyes closed (EC) at four different step heights. The plantar pressure data were recorded for 10 s and pre-processed to derive kinematic and dynamic parameters. Results: For unipedal stance, most of kinematic parameters of the subjects' right and left feet were significantly greater when the eyes were closed compared to the EO condition and increased with step height. The differences in toe load between right and left feet, open and closed eyes were extremely statistically significant (p < 0.001). The differences in midfoot load between the EO and EC conditions were statistically significant (p = 0.024) and extremely statistically significant between the right and left feet (p < 0.001). The difference in rearfoot load between EO and EC conditions was extremely statistically significant (p < 0.001) and statistically significant (p = 0.002) between the right and left feet. For bipedal stance, most of kinematic parameters of the subjects' EO and EC conditions were statistically significant between the right and left feet and increased with step height. The overall load's difference between EO and EC states was statistically significant (p = 0.003) for both feet. The overall load's difference between the right and left feet was extremely statistically significant (p < 0.001) in the EC state. The differences between the right and left feet of the forefoot and rearfoot load with EO and EC suggested that the right foot had a smaller forefoot load, but a larger rearfoot load than the left foot (p < 0.001). The differences between the forefoot and rearfoot load of the subjects' both feet with EO and EC were extremely statistically significant (p < 0.001). Conclusion: Both visual input and step height factors, even the dominant foot, act on kinematic and dynamic parameters that affect the maintenance of static balance ability.

Women with patellofemoral pain show changes in trunk and lower limb sagittal movements during single-leg squat and step-down tasks

BACKGROUND

Changes in the trunk and lower limbs' sagittal movements may cause patellofemoral pain (PFP) because they influence the forces acting on this joint.

OBJECTIVES

To compare trunk and lower limb sagittal kinematics between women with and without PFP during functional tests and to verify whether sagittal trunk kinematics are correlated with those of the knees and ankles.

METHODS

A total of 30 women with PFP and 30 asymptomatic women performed single-leg squat (SLS) and step-down (SD) tests and were filmed by a camera in the sagittal plane. The trunk inclination angle, forward knee displacement, and ankle angle were calculated.

RESULTS

The PFP group exhibited less trunk flexion (SLS, p = .006; SD, p = .016) and greater forward knee displacement (SLS, p = .001; SD, p = .004) than the asymptomatic group; there was no significant difference in ankle angle (SLS, p = .074; SD, p = .278). Correlation analysis revealed that decreased trunk flexion was associated with increased forward knee displacement (SLS, r = -0.439, p = .000; SD, r = -0.365, p = .004) and ankle dorsiflexion (SLS, r = -0.339, p = .008; SD, r = -0.356, p = .005).

CONCLUSION

Women with PFP present kinematic alterations of the trunk and knee in the sagittal plane during unipodal activities. Furthermore, the trunk and lower limb sagittal movements were interdependent.

Application of Foot Hallux Contact Force Signal for Assistive Hand Fine Control

Accurate recognition of disabled persons' behavioral intentions is the key to reconstructing hand function. Their intentions can be understood to some extent by electromyography (EMG), electroencephalogram (EEG), and arm movements, but they are not reliable enough to be generally accepted. In this paper, characteristics of foot contact force signals are investigated, and a method of expressing grasping intentions based on hallux (big toe) touch sense is proposed. First, force signals acquisition methods and devices are investigated and designed. By analyzing characteristics of signals in different areas of the foot, the hallux is selected. The peak number and other characteristic parameters are used to characterize signals, which can significantly express grasping intentions. Second, considering complex and fine tasks of the assistive hand, a posture control method is proposed. Based on this, many human-in-the-loop experiments are conducted using human-computer interaction methods. The results showed that people with hand disabilities could accurately express their grasping intentions through their toes, and could accurately grasp objects of different sizes, shapes, and hardness using their feet. The accuracy of the action completion for single-handed and double-handed disabled individuals was 99% and 98%, respectively. This proves that the method of using toe tactile sensation for assisting disabled individuals in hand control can help them complete daily fine motor activities. The method is easily acceptable in terms of reliability, unobtrusiveness, and aesthetics.

The effects of proprioceptive weighting changes on posture control in patients with chronic low back pain: a cross-sectional study

Introduction

Patients with chronic low back pain (CLBP) exhibit changes in proprioceptive weighting and impaired postural control. This study aimed to investigate proprioceptive weighting changes in patients with CLBP and their influence on posture control.

Methods

Sixteen patients with CLBP and 16 healthy controls were recruited. All participants completed the joint reposition test sense (JRS) and threshold to detect passive motion test (TTDPM). The absolute errors (AE) of the reposition and perception angles were recorded. Proprioceptive postural control was tested by applying vibrations to the triceps surae or lumbar paravertebral muscles while standing on a stable or unstable force plate. Sway length and sway velocity along the anteroposterior (AP) and mediolateral (ML) directions were assessed. Relative proprioceptive weighting (RPW) was used to evaluate the proprioception reweighting ability. Higher values indicated increased reliance on calf proprioception.

Results

There was no significant difference in age, gender, and BMI between subjects with and without CLBP. The AE and motion perception angle in the CLBP group were significantly higher than those in the control group (JRS of 15°: 2.50 (2.50) vs. 1.50 (1.42), JRS of 35°: 3.83 (3.75) vs. 1.67 (2.00), p_JRS < 0.01; 1.92 (1.18) vs. 0.68 (0.52), p_TTDPM < 0.001). The CLBP group demonstrated a significantly higher RPW value than the healthy controls on an unstable surface (0.58 ± 0.21 vs. 0.41 ± 0.26, p < 0.05). Under the condition of triceps surae vibration, the sway length (p_stable < 0.05; p_unstable < 0.001), AP velocity (p_stable < 0.01; p_unstable < 0.001) and ML velocity (p_unstable < 0.05) had significant group main effects. Moreover, when the triceps surae vibrated under the unstable surface, the differences during vibration and post vibration in sway length and AP velocity between the groups were significantly higher in the CLBP group than in the healthy group (p < 0.05). However, under the condition of lumbar paravertebral muscle vibration, no significant group main effect was observed.

Conclusion

The patients with CLBP exhibited impaired dynamic postural control in response to disturbances, potentially linked to changes in proprioceptive weighting.

Relationship between trunk control ability and respiratory function in stroke patients: A scoping review and meta-analysis

PURPOSE

Hemiparesis in stroke survivors has been reported to affect respiratory function. The relationship between trunk control and respiratory function, however, is not well understood. We aimed to map the state of the association between the trunk and respiratory function as well as evaluate the effect of a respiratory function training intervention on trunk control for stroke survivors.

METHODS

A scoping review and meta-analysis of observational and interventional studies were performed. Cochrane Library, CINAHL with Full Text (EBSCO), Medline (Ovid), and PubMed were searched using the terms stroke, respiratory, and trunk control. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to examine the sections of each report.

RESULTS

A total of 102 studies were identified, of which 12, published between 2011 and 2022, were included in the meta-analysis or narrative synthesis. Three studies were included in the meta-analysis of the correlation between trunk control and respiratory function parameters (forced vital capacity [FVC], forced expiratory volume during the first breath [FEV₁], maximal inspiratory pressure [MIP], and maximal expiratory pressure [MEP]) with effect sizes (Fisher's z) for all outcomes, which ranged from small to intermediate (between 0.21 and 0.39). Furthermore, five studies were included in the meta-analysis of the effect of respiratory function training intervention on trunk control. An overall effect size (Cohen's d) of 1.47 corresponds to a large effect. We also found significant improvements in MIP and MEP, but not in FVC and FEV₁ for stroke survivors with the interventions.

CONCLUSION

Respiratory training, use of diaphragmatic resistance exercise or abdominal breathing, use of a pressure threshold-loading device, and the performance of functional strengthening exercises for the trunk muscles, were found to increase patients' trunk control and improve their respiratory muscle strength.

Efficacy on gait and posture control after botulinum toxin A injection for lower-limb spasticity treatment after stroke: A randomized controlled trial

Objectives

To observe the efficacy of botulinum toxin type A (BoNT-A) for the spasticity of the lower-limb post-stroke on gait and posture control.

Methods

A total of 46 patients with hemiplegia gait were randomly divided into the experimental group (23 patients) and the control group (23 patients). In patients in the experimental group received injections of BoNT-A by electrical stimulation-guided. At the same time, patients of the two groups received routine physical therapy. Gait analysis, plantar pressure analysis, lower-limb Fugl-Meyer assessment (L-FMA), 10 meter walking test (10MWT), timed "Up and Go" test (TUGT), and modified Ashworth Scale assess (MAS) of the lower limbs were performed at 0, 1, 4, and 12 weeks after treatment.

Results

At 1, 4, and 12 weeks after treatment, the L-FMA, stride length, speed, and TUGT significantly improved than 0 week in both groups. The L-FMA and peak of forefoot pressure, and MAS results in the experimental group were better than those in the control group at 4 and 12 weeks. The TUGT, speed, and stride length in experimental group was significantly shortened than that in control group at 1, 4, and 12 weeks.

Conclusion

Botulinum toxin type A injection can improve motor functions of the lower limb, gait, spasticity, forefoot pressure, and posture control of patients after stroke.

Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis

The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait _ML and Entropy _ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation.

Reaching Task in Rats: Quantitative Evaluation and Effects of 6-OHDA into the Striatum

In this study, we developed an evaluation method using image analysis for reaching tasks. Using this method, we studied forearm function during the reaching task in rats that received a unilateral injection of 6-OHDA into the striatum. The success ratio of the reaching task reduced to 40.5% seven days after the injection. In addition, significant changes were observed in the pronation angle of the forearm, posture control, and targeting (i.e., the distance between all fingertips and the center of the target pellet). Thus, unilateral injection of 6-OHDA reduces dopaminergic function in the brain and causes deterioration of forearm function and posture control in the reaching task.

Haptic Information Improvement on Postural Sway is Information-Dependent But Not Influenced by Cognitive Task

Young adults reduce their sway in both light touch (LT) and anchor systems (AS), however, the cognitive involvement in these tasks is unknown. This study investigated postural control in young adults standing upright using either LT or AS, concomitantly with a cognitive task (counting). Nine adults (26 ± 7.4 years) stood in the upright tandem stance with eyes closed, with/without LT, AS (force <2 N), and a cognitive task. The mean sway amplitude of the trunk, right wrist, and shoulder ellipse area, as well as the mean force during LT and AS were obtained. The cognitive task did not influence the magnitude of trunk sway or the mean force in the LT and AS conditions. The trunk sway magnitude was reduced in the AS and even further in LT. Wrist and shoulder variability was larger in the AS than in the LT. Based on these results, we conclude that enhanced sensory cues provided by LT and AS reduce trunk sway with little or no attentional demands.

Fast tuning of posture control by visual feedback underlies gaze stabilization in walking Drosophila

Locomotion requires a balance between mechanical stability and movement flexibility to achieve behavioral goals despite noisy neuromuscular systems, but rarely is it considered how this balance is orchestrated. We combined virtual reality tools with quantitative analysis of behavior to examine how Drosophila uses self-generated visual information (reafferent visual feedback) to control gaze during exploratory walking. We found that flies execute distinct motor programs coordinated across the body to maximize gaze stability. However, the presence of inherent variability in leg placement relative to the body jeopardizes fine control of gaze due to posture-stabilizing adjustments that lead to unintended changes in course direction. Surprisingly, whereas visual feedback is dispensable for head-body coordination, we found that self-generated visual signals tune postural reflexes to rapidly prevent turns rather than to promote compensatory rotations, a long-standing idea for visually guided course control. Together, these findings support a model in which visual feedback orchestrates the interplay between posture and gaze stability in a manner that is both goal dependent and motor-context specific.

Effects of Tai Chi exercise on improving walking function and posture control in elderly patients with knee osteoarthritis: A systematic review and meta-analysis

OBJECTIVE

It remains unclear whether Tai Chi is effective for walking function and posture control improvements in aged populations with knee osteoarthritis. The aim of this study was to systematically evaluate the effects of Tai Chi on improving walking function and posture control in elderly patients with knee osteoarthritis by updating the latest trial evidence.

METHODS

Web of Science, PubMed/Medline, Embase, Scopus, PEDro, and Cochrane library were searched up to October 1, 2020 to identify RCTs evaluating Tai Chi for improving walking function and posture control in older adults with knee osteoarthritis. The primary outcomes were walking function and posture control. Meta-analysis was performed with RevMan Version 5.3 software.

RESULTS

A total of 603 participants with knee osteoarthritis in the 11 trials were included. The results of meta-analysis showed that: The Tai Chi group was associated with better performance in 6-minute walk test (6 MWT), time up and go test (TUG) and "Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index" Physical Function Score than the control group ([MD: 46.67, 95% CI 36.91-56.43, P < .001]), ([MD: -0.89, 95% CI -1.16 to -0.61, P < .001]), ([MD: -11.28, 95% CI -13.33 to -9.24, P < .001]).

CONCLUSION

This meta-analysis provided evidence from 11 RCTs that Tai Chi could be an excellent physical training strategy for improving walking function and posture control in older adults with knee osteoarthritis. Assuming that Tai Chi is at least effective and safe in most areas, it can be used as an adjuvant and reliable physical training strategy for walking function upgrading and balance control improvements for older patients with knee osteoarthritis.

Distributed processing of load and movement feedback in the premotor network controlling an insect leg joint

In legged animals, integration of information from various proprioceptors in and on the appendages by local premotor networks in the central nervous system is crucial for controlling motor output. To ensure posture maintenance and precise active movements, information about limb loading and movement is required. In insects, various groups of campaniform sensilla (CS) measure forces and loads acting in different directions on the leg, and the femoral chordotonal organ (fCO) provides information about movement of the femur-tibia (FTi) joint. In this study, we used extra- and intracellular recordings of extensor tibiae (ExtTi) and retractor coxae (RetCx) motor neurons (MNs) and identified local premotor nonspiking interneurons (NSIs) and mechanical stimulation of the fCO and tibial or trochanterofemoral CS (tiCS, tr/fCS), to investigate the premotor network architecture underlying multimodal proprioceptive integration. We found that load feedback from tiCS altered the strength of movement-elicited resistance reflexes and determined the specificity of ExtTi and RetCx MN responses to various load and movement stimuli. These responses were mediated by a common population of identified NSIs into which synaptic inputs from the fCO, tiCS, and tr/fCS are distributed, and whose effects onto ExtTi MNs can be antagonistic for both stimulus modalities. Multimodal sensory signal interaction was found at the level of single NSIs and MNs. The results provide evidence that load and movement feedback are integrated in a multimodal, distributed local premotor network consisting of antagonistic elements controlling movements of the FTi joint, thus substantially extending current knowledge on how legged motor systems achieve fine-tuned motor control.NEW & NOTEWORTHY Proprioception is crucial for motor control in legged animals. We show the extent to which processing of movement (fCO) and load (CS) signals overlaps in the local premotor network of an insect leg. Multimodal signals converge onto the same set of interneurons, and our knowledge about distributed, antagonistic processing is extended to incorporate multiple modalities within one perceptual neuronal framework.

Linear and Non-linear Dynamic Methods Toward Investigating Proprioception Impairment in Non-specific Low Back Pain Patients

Central nervous system (CNS) uses vision, vestibular, and somatosensory information to maintain body stability. Research has shown that there is more lumbar proprioception error among low back pain (LBP) individuals as compared to healthy people. In this study, two groups of 20 healthy people and 20 non-specific low back pain (NSLBP) participants took part in this investigation. This investigation focused on somatosensory sensors and in order to alter proprioception, a vibrator (frequency of 70 Hz, amplitude of 0.5 mm) was placed on the soleus muscle area of each leg and two vibrators were placed bilaterally across the lower back muscles. Individuals, whose vision was occluded, were placed on two surfaces (foam and rigid) on force plate, and trunk angles were recorded simultaneously. Tests were performed in eight separate trials; the independent variables were vibration (four levels) and surface (two levels) for within subjects and two groups (healthy and LBP) for between subjects (4 × 2 × 2). MANOVA and multi-factor ANOVA tests were done. Linear parameters for center of pressure (COP) [deviation of amplitude, deviation of velocity, phase plane portrait (PPP), and overall mean velocity] and non-linear parameters for COP and trunk angle [recurrence quantification analysis (RQA) and Lyapunov exponents] were chosen as dependent variables. Results indicated that NSLBP individuals relied more on ankle proprioception for postural stability. Similarly, RQA parameters for the COP on both sides and for the trunk sagittal angle indicated more repeated patterns of movement among the LBP cohort. Analysis of short and long Lyapunov exponents showed that people with LBP caused no use of all joints in their bodies (non-flexible), are less stable than healthy subjects.

Dual-Task Interference Between Swimming and Verbal Memory

OBJECTIVE

A dual-task study was performed to explore the performance effects for swimming, word recall, and the combination of the two tasks performed simultaneously.

BACKGROUND

Dual-task interference studies have been performed for a variety of tasks; however, there has not been much dual-task interference research where one of the tasks is a naturalistic physically strenuous task. Swimming is a unique physical task that requires spatial orientation on three dimensional axes, similar to that of flying, but has no risk of falling. Previous studies have been conducted in other activity combinations with word-free recall, such as running and climbing, but swimming has yet to be explored.

METHOD

A verbal memory recall task and swimming task were performed in isolated (single-task) and simultaneous conditions. A comparison of effects across these different activities was also explored.

RESULTS

Swimming and the word-recall task resulted in significant dual-task interference: almost as much as when word recall was paired with another verbal task, but more than running and less than climbing.

CONCLUSION

Consistent with other dual-task studies, this study observed dual-task interference between the physical swimming task and the cognitive verbal memory task.

APPLICATION

Future technologies and training for personnel who engage in water rescue or commercial diving, such as underwater welding and fiber optic cable, may be improved by these findings.

Clinical factors associated with trunk control after stroke: A prospective study

INTRODUCTION

Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days.

METHODS

This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control.

RESULTS

The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively.

CONCLUSION

Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.

The effectiveness of rearfoot medial wedge intervention on balance for athletes with chronic ankle instability

BACKGROUND

Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI.

METHODS

The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test.

RESULTS

The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ± 25.22 to 41.24 ± 21 48 (P = .015) in CAI group after medial wedge intervention.

CONCLUSION

Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.

Biomechanical control of beech pole verticality (Fagus sylvatica) before and after thinning: theoretical modelling and ground-truth data using terrestrial LiDAR

PREMISE OF THE STUDY

Thinning is a frequent disturbance in managed forests, especially to increase radial growth. Due to buckling and bending risk associated with height and mass growth, tree verticality is strongly constrained in slender trees growing in dense forests and poor light conditions. Tree verticality is controlled by uprighting movements implemented from local curvatures induced by wood maturation stresses and/or eccentric radial growth. This study presents the first attempt to compare the real uprighting movements in mature trees using a theoretical model of posture control.

METHODS

Stem lean and curvature were measured by Terrestrial LiDAR Scanner (TLS) technology before and 6 years after thinning and compared to unthinned control poles. Measures for several tree and wood traits were pooled together to implement a widely used biomechanical model of tree posture control. Changes in observed stem lean were then compared with the model predictions, and discrepancies were reviewed.

KEY RESULTS

Even under a highly constrained environment, most control poles were able to counterbalance gravitational curvature and avoid sagging. Thinning stimulated uprighting movements. The theoretical uprighting curvature rate increased just after thinning, then slowed after 2 years, likely due to the stem diameter increase. The biomechanical model overestimated the magnitude of uprighting.

CONCLUSIONS

Most suppressed beech poles maintain a constant lean angle, and uprighting movements occur after thinning, indicating that stem lean is plastic in response to light conditions. Acclimation of posture control to other changes in growth condition should be investigated, and lean angles should be measured in forest inventories as an indicator of future wood quality.

Neuromuscular and Kinematic Adaptation in Response to Reactive Balance Training - a Randomized Controlled Study Regarding Fall Prevention

Slips and stumbles are main causes of falls and result in serious injuries. Balance training is widely applied for preventing falls across the lifespan. Subdivided into two main intervention types, biomechanical characteristics differ amongst balance interventions tailored to counteract falls: conventional balance training (CBT) referring to a balance task with a static ledger pivoting around the ankle joint versus reactive balance training (RBT) using externally applied perturbations to deteriorate body equilibrium. This study aimed to evaluate the efficacy of reactive, slip-simulating RBT compared to CBT in regard to fall prevention and to detect neuromuscular and kinematic dependencies. In a randomized controlled trial, 38 participants were randomly allocated either to CBT or RBT. To simulate stumbling scenarios, postural responses were assessed to posterior translations in gait and stance perturbation before and after 4 weeks of training. Surface electromyography during short- (SLR), medium- (MLR), and long-latency response of shank and thigh muscles as well as ankle, knee, and hip joint kinematics (amplitudes and velocities) were recorded. Both training modalities revealed reduced angular velocity in the ankle joint (P < 0.05) accompanied by increased shank muscle activity in SLR (P < 0.05) during marching in place perturbation. During stance perturbation and marching in place perturbation, hip angular velocity was decreased after RBT (P from TTEST, P_t < 0.05) accompanied by enhanced thigh muscle activity (SLR, MLR) after both trainings (P < 0.05). Effect sizes were larger for the RBT-group during stance perturbation. Thus, both interventions revealed modified stabilization strategies for reactive balance recovery after surface translations. Characterized by enhanced reflex activity in the leg muscles antagonizing the surface translations, balance training is associated with improved neuromuscular timing and accuracy being relevant for postural control. This may result in more efficient segmental stabilization during fall risk situations, independent of the intervention modality. More pronounced modulations and higher effect sizes after RBT in stance perturbation point toward specificity of training adaptations, with an emphasis on the proximal body segment for RBT. Outcomes underline the benefits of balance training with a clear distinction between RBT and CBT being relevant for training application over the lifespan.

Adaptation of perturbation to postural control in individuals with diabetic peripheral neuropathy

Loss of sensation in the feet due to diabetic peripheral neuropathy can cause deterioration of postural control and result in higher risk of trips, slips or falls. In the literature, many studies have reported that people with diabetic peripheral neuropathy tend to show greater displacement of body sway than normal people when the base of support is disrupted. But not much is known about postural characteristics of diabetics with peripheral neuropathy at the moment of postural stability disruptions and during the time span for recovering stability. The objective of this study was to analyze differences of postural characteristics between diabetics with peripheral neuropathy and diabetics without peripheral neuropathy. A learning effect of perturbation was found for the diabetic peripheral neuropathy group in the posterior direction of perturbation during the first phase, which may indicate that it could be possible to design a postural control program for those people.

Posture Control-Human-Inspired Approaches for Humanoid Robot Benchmarking: Conceptualizing Tests, Protocols and Analyses

Posture control is indispensable for both humans and humanoid robots, which becomes especially evident when performing sensorimotor tasks such as moving on compliant terrain or interacting with the environment. Posture control is therefore targeted in recent proposals of robot benchmarking in order to advance their development. This Methods article suggests corresponding robot tests of standing balance, drawing inspirations from the human sensorimotor system and presenting examples from robot experiments. To account for a considerable technical and algorithmic diversity among robots, we focus in our tests on basic posture control mechanisms, which provide humans with an impressive postural versatility and robustness. Specifically, we focus on the mechanically challenging balancing of the whole body above the feet in the sagittal plane around the ankle joints in concert with the upper body balancing around the hip joints. The suggested tests target three key issues of human balancing, which appear equally relevant for humanoid bipeds: (1) four basic physical disturbances (support surface (SS) tilt and translation, field and contact forces) may affect the balancing in any given degree of freedom (DoF). Targeting these disturbances allows us to abstract from the manifold of possible behavioral tasks. (2) Posture control interacts in a conflict-free way with the control of voluntary movements for undisturbed movement execution, both with "reactive" balancing of external disturbances and "proactive" balancing of self-produced disturbances from the voluntary movements. Our proposals therefore target both types of disturbances and their superposition. (3) Relevant for both versatility and robustness of the control, linkages between the posture control mechanisms across DoFs provide their functional cooperation and coordination at will and on functional demands. The suggested tests therefore include ankle-hip coordination. Suggested benchmarking criteria build on the evoked sway magnitude, normalized to robot weight and Center of mass (COM) height, in relation to reference ranges that remain to be established. The references may include human likeness features. The proposed benchmarking concept may in principle also be applied to wearable robots, where a human user may command movements, but may not be aware of the additionally required postural control, which then needs to be implemented into the robot.

Human Postural Control

From ancient Greece to nowadays, research on posture control was guided and shaped by many concepts. Equilibrium control is often considered part of postural control. However, two different levels have become increasingly apparent in the postural control system, one level sets a distribution of tonic muscle activity (“posture”) and the other is assigned to compensate for internal or external perturbations (“equilibrium”). While the two levels are inherently interrelated, both neurophysiological and functional considerations point toward distinct neuromuscular underpinnings. Disturbances of muscle tone may in turn affect movement performance. The unique structure, specialization and properties of skeletal muscles should also be taken into account for understanding important peripheral contributors to postural regulation. Here, we will consider the neuromechanical basis of habitual posture and various concepts that were rather influential in many experimental studies and mathematical models of human posture control.

Locomotor Sub-functions for Control of Assistive Wearable Robots

A primary goal of comparative biomechanics is to understand the fundamental physics of locomotion within an evolutionary context. Such an understanding of legged locomotion results in a transition from copying nature to borrowing strategies for interacting with the physical world regarding design and control of bio-inspired legged robots or robotic assistive devices. Inspired from nature, legged locomotion can be composed of three locomotor sub-functions, which are intrinsically interrelated: Stance: redirecting the center of mass by exerting forces on the ground. Swing: cycling the legs between ground contacts. Balance: maintaining body posture. With these three sub-functions, one can understand, design and control legged locomotory systems with formulating them in simpler separated tasks. Coordination between locomotor sub-functions in a harmonized manner appears then as an additional problem when considering legged locomotion. However, biological locomotion shows that appropriate design and control of each sub-function simplifies coordination. It means that only limited exchange of sensory information between the different locomotor sub-function controllers is required enabling the envisioned modular architecture of the locomotion control system. In this paper, we present different studies on implementing different locomotor sub-function controllers on models, robots, and an exoskeleton in addition to demonstrating their abilities in explaining humans' control strategies.

Dynamic Determinants of the Uncontrolled Manifold during Human Quiet Stance

Human postural sway during stance arises from coordinated multi-joint movements. Thus, a sway trajectory represented by a time-varying postural vector in the multiple-joint-angle-space tends to be constrained to a low-dimensional subspace. It has been proposed that the subspace corresponds to a manifold defined by a kinematic constraint, such that the position of the center of mass (CoM) of the whole body is constant in time, referred to as the kinematic uncontrolled manifold (kinematic-UCM). A control strategy related to this hypothesis (CoM-control-strategy) claims that the central nervous system (CNS) aims to keep the posture close to the kinematic-UCM using a continuous feedback controller, leading to sway patterns that mostly occur within the kinematic-UCM, where no corrective control is exerted. An alternative strategy proposed by the authors (intermittent control-strategy) claims that the CNS stabilizes posture by intermittently suspending the active feedback controller, in such a way to allow the CNS to exploit a stable manifold of the saddle-type upright equilibrium in the state-space of the system, referred to as the dynamic-UCM, when the state point is on or near the manifold. Although the mathematical definitions of the kinematic- and dynamic-UCM are completely different, both UCMs play similar roles in the stabilization of multi-joint upright posture. The purpose of this study was to compare the dynamic performance of the two control strategies. In particular, we considered a double-inverted-pendulum-model of postural control, and analyzed the two UCMs defined above. We first showed that the geometric configurations of the two UCMs are almost identical. We then investigated whether the UCM-component of experimental sway could be considered as passive dynamics with no active control, and showed that such UCM-component mainly consists of high frequency oscillations above 1 Hz, corresponding to anti-phase coordination between the ankle and hip. We also showed that this result can be better characterized by an eigenfrequency associated with the dynamic-UCM. In summary, our analysis highlights the close relationship between the two control strategies, namely their ability to simultaneously establish small CoM variations and postural stability, but also make it clear that the intermittent control hypothesis better explains the spectral characteristics of sway.

Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects

CONCLUSION

After repeated snowboard exercises in the virtual reality (VR) world with increasing time lags in trials 3-8, it is suggested that the adaptation to repeated visual-vestibulosomatosensory conflict in the VR world improved dynamic posture control and motor performance in the real world without the development of motion sickness.

OBJECTIVES

The VR technology was used and the effects of repeated snowboard exercise examined in the VR world with time lags between visual scene and body rotation on the head stability and slalom run performance during exercise in healthy subjects.

METHODS

Forty-two healthy young subjects participated in the study. After trials 1 and 2 of snowboard exercise in the VR world without time lag, trials 3-8 were conducted with 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6 s time lags of the visual scene that the computer creates behind board rotation, respectively. Finally, trial 9 was conducted without time lag. Head linear accelerations and subjective slalom run performance were evaluated.

RESULTS

The standard deviations of head linear accelerations in inter-aural direction were significantly increased in trial 8, with a time lag of 0.6 s, but significantly decreased in trial 9 without a time lag, compared with those in trial 2 without a time lag. The subjective scores of slalom run performance were significantly decreased in trial 8, with a time lag of 0.6 s, but significantly increased in trial 9 without a time lag, compared with those in trial 2 without a time lag. Motion sickness was not induced in any subjects.

Intermittent Feedback-Control Strategy for Stabilizing Inverted Pendulum on Manually Controlled Cart as Analogy to Human Stick Balancing

The stabilization of an inverted pendulum on a manually controlled cart (cart-inverted-pendulum; CIP) in an upright position, which is analogous to balancing a stick on a fingertip, is considered in order to investigate how the human central nervous system (CNS) stabilizes unstable dynamics due to mechanical instability and time delays in neural feedback control. We explore the possibility that a type of intermittent time-delayed feedback control, which has been proposed for human postural control during quiet standing, is also a promising strategy for the CIP task and stick balancing on a fingertip. Such a strategy hypothesizes that the CNS exploits transient contracting dynamics along a stable manifold of a saddle-type unstable upright equilibrium of the inverted pendulum in the absence of control by inactivating neural feedback control intermittently for compensating delay-induced instability. To this end, the motions of a CIP stabilized by human subjects were experimentally acquired, and computational models of the system were employed to characterize the experimental behaviors. We first confirmed fat-tailed non-Gaussian temporal fluctuation in the acceleration distribution of the pendulum, as well as the power-law distributions of corrective cart movements for skilled subjects, which was previously reported for stick balancing. We then showed that the experimental behaviors could be better described by the models with an intermittent delayed feedback controller than by those with the conventional continuous delayed feedback controller, suggesting that the human CNS stabilizes the upright posture of the pendulum by utilizing the intermittent delayed feedback-control strategy.

Sensory reweighting dynamics following removal and addition of visual and proprioceptive cues

Removing or adding sensory cues from one sensory system during standing balance causes a change in the contribution of the remaining sensory systems, a process referred to as sensory reweighting. While reweighting changes have been described in many studies under steady-state conditions, less is known about the temporal dynamics of reweighting following sudden transitions to different sensory conditions. The present study changed sensory conditions by periodically adding or removing visual (lights On/Off) or proprioceptive cues (surface sway referencing On/Off) in 12 young, healthy subjects. Evidence for changes in sensory contributions to balance was obtained by measuring the time course of medial-lateral sway responses to a constant-amplitude 0.56-Hz sinusoidal stimulus, applied as support surface tilt (proprioceptive contribution), as visual scene tilt (visual contribution), or as binaural galvanic vestibular stimulation (vestibular contribution), and by analyzing the time course of sway variability. Sine responses and variability of body sway velocity showed significant changes following transitions and were highly correlated under steady-state conditions. A dependence of steady-state responses on upcoming transitions was observed, suggesting that knowledge of impending changes can influence sensory weighting. Dynamic changes in sway in the period immediately following sensory transitions were very inhomogeneous across sway measures and in different experimental tests. In contrast to steady-state results, sway response and variability measures were not correlated with one another in the dynamic transition period. Several factors influence sway responses following addition or removal of sensory cues, partly instigated by but also obscuring the effects of reweighting dynamics.

Smooth enlargement of human standing sway by instability due to weak reaction floor and noise

Human quiet standing is accompanied by body sway. The amplitude of this body sway is known to be larger than would be predicted from simple noise effects, and sway characteristics are changed by neurological disorders. This large sway is thought to arise from nonlinear control with prolonged periods of no control (intermittent control), and a nonlinear control system of this kind has been predicted to exhibit bifurcation. The presence of stability-dependent transition enables dynamic reaction that depends on the stability of the environment, and can explain the change in sway characteristics that accompanies some neurological disorders. This research analyses the characteristics of a system model that induces transition, and discusses whether human standing reflects such a mechanism. In mathematical analysis of system models, (intermittent control-like) nonlinear control with integral control is shown to exhibit Hopf bifurcation. Moreover, from the analytical solution of the system model with noise, noise is shown to work to smooth the enlargement of sway around the bifurcation point. This solution is compared with measured human standing sway on floors with different stabilities. By quantitatively comparing the control parameters between human observation and model prediction, enlargement of sway is shown to appear as predicted by the model analysis.

Effects of galvanic vestibular stimulation combined with physical therapy on pusher behavior in stroke patients: a case series

BACKGROUND

A recent study investigated the effects of galvanic vestibular stimulation (GVS) on pusher behavior (PB) in post-stroke patients. However, there have been no reports about the effects of multisession GVS on PB.

OBJECTIVE

The purpose of this study was to investigate the feasibility and effects of multisession GVS combined with physical therapy for PB in stroke patients.

METHODS

Two stroke patients who showed PB were enrolled. The ABAB single-case design was used. Each phase lasted 1 wk. In phases A1 and A2, the patients underwent a 60-min-long physical therapy session 5 days a week. In phases B1 and B2, they underwent GVS for 20 min before each physical therapy session, and then the same physical therapy program as in phases A1 and A2 were performed. PB was evaluated using the Scale for Contraversive Pushing (SCP) and the Burke Lateropulsion Scale (BLS). Outcomes were tested at the baseline and after each phase.

RESULTS

In both patients, the SCP scores were reduced only during phase B2. Although the BLS scores improved at the A1 phase, a larger improvement was seen at the two B phases.

CONCLUSIONS

Multisession GVS combined with physical therapy may have positive effects on PB in clinical setting.

Termination of vestibulospinal fibers arising from the spinal vestibular nucleus in the mouse spinal cord

The present study investigated the vestibulospinal system which originates from the spinal vestibular nucleus (SpVe) with both retrograde and anterograde tracer injections. We found that fluoro-gold (FG) labeled neurons were found bilaterally with a contralateral predominance after FG injections into the upper lumbar cord. Anterogradely labeled fibers from the rostral SpVe traveled in the medial part of the ventral funiculus ipsilaterally and the dorsolateral funiculus bilaterally in the cervical cord. They mainly terminated in laminae 5-8, and 10 of the ipsilateral spinal cord. The contralateral side had fewer fibers and they were found in laminae 6-8, and 10. In the thoracic cord, fibers were also found to terminate in bilateral intermediolateral columns. In the lumbar and lower cord, fibers were mainly found in the dorsolateral funiculus bilaterally and they terminated predominantly in laminae 3-7 contralaterally. Anterogradely labeled fibers from the caudal SpVe did not travel in the medial part of the ventral funiculus but in the dorsolateral funiculus bilaterally. They mainly terminated in laminae 3-8 and 10 contralaterally. The present study is the first to describe the termination of vestibulospinal fibers arising from the SpVe in the spinal cord. It will lay the anatomical foundation for those who investigate the physiological role of vestibulospinal fibers and potentially target these fibers during rehabilitation after stroke, spinal cord injury, or vestibular organ injury.

Sensory synergy as environmental input integration

The development of a method to feed proper environmental inputs back to the central nervous system (CNS) remains one of the challenges in achieving natural movement when part of the body is replaced with an artificial device. Muscle synergies are widely accepted as a biologically plausible interpretation of the neural dynamics between the CNS and the muscular system. Yet the sensorineural dynamics of environmental feedback to the CNS has not been investigated in detail. In this study, we address this issue by exploring the concept of sensory synergy. In contrast to muscle synergy, we hypothesize that sensory synergy plays an essential role in integrating the overall environmental inputs to provide low-dimensional information to the CNS. We assume that sensor synergy and muscle synergy communicate using these low-dimensional signals. To examine our hypothesis, we conducted posture control experiments involving lateral disturbance with nine healthy participants. Proprioceptive information represented by the changes on muscle lengths were estimated by using the musculoskeletal model analysis software SIMM. Changes on muscles lengths were then used to compute sensory synergies. The experimental results indicate that the environmental inputs were translated into the two dimensional signals and used to move the upper limb to the desired position immediately after the lateral disturbance. Participants who showed high skill in posture control were found to be likely to have a strong correlation between sensory and muscle signaling as well as high coordination between the utilized sensory synergies. These results suggest the importance of integrating environmental inputs into suitable low-dimensional signals before providing them to the CNS. This mechanism should be essential when designing the prosthesis' sensory system to make the controller simpler.

Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training

For consciously performed motor tasks executed in a defined and constant way, both motor imagery (MI) and action observation (AO) have been shown to promote motor learning. It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment. The present study therefore investigated the influence of MI balance training (MI_BT) and a balance training combining AO and MI (AO+MI_BT) on postural control of undisturbed and disturbed upright stance on unstable ground. As spinal reflex excitability after classical (i.e., physical) balance training (BT) is generally decreased, we tested whether non-physical BT also has an impact on spinal reflex circuits. Thirty-six participants were randomly allocated into an MI_BT group, in which participants imagined postural exercises, an AO+MI_BT group, in which participants observed videos of other people performing balance exercises and imagined being the person in the video, and a non-active control group (CON). Before and after 4 weeks of non-physical training, balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance. Soleus H-reflexes were recorded during stable and unstable stance. The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT. Spinal reflex excitability remained unchanged. This is the first study showing that non-physical training (MI_BT and AO+MI_BT) not only promotes motor learning of “rigid” postural tasks but also improves performance of highly variable and unpredictable balance actions. These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients.

Using virtual reality to augment perception, enhance sensorimotor adaptation, and change our minds

Technological advances that involve human sensorimotor processes can have both intended and unintended effects on the central nervous system (CNS). This mini review focuses on the use of virtual environments (VE) to augment brain functions by enhancing perception, eliciting automatic motor behavior, and inducing sensorimotor adaptation. VE technology is becoming increasingly prevalent in medical rehabilitation, training simulators, gaming, and entertainment. Although these VE applications have often been shown to optimize outcomes, whether it be to speed recovery, reduce training time, or enhance immersion and enjoyment, there are inherent drawbacks to environments that can potentially change sensorimotor calibration. Across numerous VE studies over the years, we have investigated the effects of combining visual and physical motion on perception, motor control, and adaptation. Recent results from our research involving exposure to dynamic passive motion within a visually-depicted VE reveal that short-term exposure to augmented sensorimotor discordance can result in systematic aftereffects that last beyond the exposure period. Whether these adaptations are advantageous or not, remains to be seen. Benefits as well as risks of using VE-driven sensorimotor stimulation to enhance brain processes will be discussed.

Sensory reweighting dynamics in human postural control

Healthy humans control balance during stance by using an active feedback mechanism that generates corrective torque based on a combination of movement and orientation cues from visual, vestibular, and proprioceptive systems. Previous studies found that the contribution of each of these sensory systems changes depending on perturbations applied during stance and on environmental conditions. The process of adjusting the sensory contributions to balance control is referred to as sensory reweighting. To investigate the dynamics of reweighting for the sensory modalities of vision and proprioception, 14 healthy young subjects were exposed to six different combinations of continuous visual scene and platform tilt stimuli while sway responses were recorded. Stimuli consisted of two components: 1) a pseudorandom component whose amplitude periodically switched between low and high amplitudes and 2) a low-amplitude sinusoidal component whose amplitude remained constant throughout a trial. These two stimuli were mathematically independent of one another and, thus, permitted separate analyses of sway responses to the two components. For all six stimulus combinations, the sway responses to the constant-amplitude sine were influenced by the changing amplitude of the pseudorandom component in a manner consistent with sensory reweighting. Results show clear evidence of intra- and intermodality reweighting. Reweighting dynamics were asymmetric, with slower reweighting dynamics following a high-to-low transition in the pseudorandom stimulus amplitude compared with low-to-high amplitude shifts, and were also slower for inter- compared with intramodality reweighting.

Static and dynamic posture control in postlingual cochlear implanted patients: effects of dual-tasking, visual and auditory inputs suppression

Posture control is based on central integration of multisensory inputs, and on internal representation of body orientation in space. This multisensory feedback regulates posture control and continuously updates the internal model of body's position which in turn forwards motor commands adapted to the environmental context and constraints. The peripheral localization of the vestibular system, close to the cochlea, makes vestibular damage possible following cochlear implant (CI) surgery. Impaired vestibular function in CI patients, if any, may have a strong impact on posture stability. The simple postural task of quiet standing is generally paired with cognitive activity in most day life conditions, leading therefore to competition for attentional resources in dual-tasking, and increased risk of fall particularly in patients with impaired vestibular function. This study was aimed at evaluating the effects of postlingual cochlear implantation on posture control in adult deaf patients. Possible impairment of vestibular function was assessed by comparing the postural performance of patients to that of age-matched healthy subjects during a simple postural task performed in static (stable platform) and dynamic (platform in translation) conditions, and during dual-tasking with a visual or auditory memory task. Postural tests were done in eyes open (EO) and eyes closed (EC) conditions, with the CI activated (ON) or not (OFF). Results showed that the postural performance of the CI patients strongly differed from the controls, mainly in the EC condition. The CI patients showed significantly reduced limits of stability and increased postural instability in static conditions. In dynamic conditions, they spent considerably more energy to maintain equilibrium, and their head was stabilized neither in space nor on trunk: they behaved dynamically without vision like an inverted pendulum while the controls showed a whole body rigidification strategy. Hearing (prosthesis on) as well as dual-tasking did not really improve the dynamic postural performance of the CI patients. We conclude that CI patients become strongly visual dependent mainly in challenging postural conditions, a result they have to be awarded of particularly when getting older.

Statistical validation of wavelet transform coherence method to assess the transfer of calf muscle activation to blood pressure during quiet standing

BACKGROUND

Continuous and discrete wavelet transforms have been established as valid tools to analyze non-stationary and transient signals over Fourier domain methods. Additionally, Fourier transform based coherence methods provide aggregate results but do not provide insights into the changes in coherent behavior over time, hence limiting their utility.

METHODS

Statistical validation of the wavelet transform coherence (WTC) was conducted with simulated data sets. Time frequency maps of signal coherence between calf muscle electromyography (EMG) and blood pressure (BP) were obtained by WTC to provide further insight into their interdependent time-varying behavior via the skeletal muscle pump during quiet stance. Data were collected from healthy young males (n = 5, 19-28 years) during a quiet stance on a balance platform. Waveforms for EMG and BP were acquired and processed for further analysis.

RESULTS

Low values of bias and standard deviation (< 0.1) were observed and the use of both simulated and real data demonstrated that the WTC method was able to identify time points of significant coherence (> Threshold) and objectively detect existence of interdependent activity between the calf muscle EMG and blood pressure.

CONCLUSIONS

The WTC method effectively identified the presence of linear coupling between the EMG and BP signals during quiet standing. Future studies with more human data are needed to establish the exact characteristics of the identified relationship.

Anticipatory postural adjustments in dart throwing

The aim of this study was to explore the effects of accuracy constraints on the characteristics of anticipatory postural adjustments (APA) in a task that involves a movement consisting of a controlled phase and a ballistic phase. It was hypothesized that APA scaling with task parameters (target size) would be preserved even when the task is performed by muscles that have no direct effects on APA. Sixteen healthy right handed subjects participated in the study. All participants had no prior experience in dart throwing. Subjects’ average age was 24.1 ± 1.9 years. A force platform and a motion capture system were used to register kinetics of the body and kinematics of the throwing arm and throwing accuracy. The experiment consisted of six series of twenty consecutive dart throws to a specified target. Target sizes (T2–T6) were set at 25%, 50%, 75%, 125% and 150% of target 1 (T1) initially set as the spread of the last 20 throws in a 50 throw training session. This allowed to distinguish six indexes of difficulty (ID’s) ranging from 2,9 to 5,9. A one-way ANOVA for repeated measures was used for statistical analysis. Results of ANOVA showed a significant effect of target size at Constant Error but no effect at APA time. There were also no significant differences between hit and miss throws. From a control perspective, it can be stated that changes in central commands did not lead to changes in APA time in the analyzed motor task.

Trunk orientation, stability, and quadrupedalism

Interesting cases of human quadrupedalism described by Tan and Colleagues (2005–2012) have attracted the attention of geneticists, neurologists, and anthropologists. Since his first publications in 2005, the main attention has focused on the genetic aspects of disorders that lead to quadrupedalism within an evolutionary framework. In recent years this area has undergone a convincing critique (Downey, 2010) and ended with a call “… to move in a different direction … away from thinking solely in terms of genetic abnormality and evolutionary atavism.” We consider quadrupedalism as a “natural experiment” that may contribute to our knowledge of the physiological mechanisms underlying our balance system and our tendency toward normal (upright) posture. Bipedalism necessitates a number of characteristics that distinguish us from our ancestors and present-day mammals, including: size and shape of the bones of the foot, structure of the axial and proximal musculature, and the orientation of the human body and head. In this review we address the results of experimental studies on the mechanisms that stabilize the body in healthy people, as well as how these mechanisms may be disturbed in various forms of clinical pathology. These disturbances are related primarily to automatic rather than voluntary control of posture and suggest that human quadrupedalism is a behavior that can result from adaptive processes triggered by disorders in postural tone and environmental cues. These results will serve as a starting point for comparing and contrasting bi- and quadrupedalism.

Performance and characteristics of an IR localizing system for radiation therapy

We report the development of a new system for interactive patient posture, position and respiratory control during radiation therapy treatment. The system consists of an infrared camera, retro-reflective markers and dedicated software that makes it practical to use in the clinic. The system is designed to be used with multiple retro-reflective markers to monitor not only position, but also the posture of the patient in real time. Specific features of the system include: 1. The system reports an absolute misalignment at several points on a patients, and also provides feedbacks on any necessary adjustments in terms of site specific set-up parameters, such as focus to surface distance (PIN), superior and inferior alignment, chest-wall angle, etc. 2. The system is based on the set of predefined templates containing number and position of control points and feedback parameters developed for different treatment sites. 3. A "virtual portal vision" procedure is developed to project organ contours in the beams-eye-view (BEV) based on the marker locations obtained in real time and compare them with digitally reconstructed radiographs (DRRs) from CT simulation. Assuming good correlation between external markers and internal anatomy, the system offers the possibility of mimicking a verification procedure without taking port-films, which can potentially reduce the setup time. In this paper, we concentrate on system properties and performance, while initial applications on a number of clinical sites is ongoing. Accuracy and precision of this system are evaluated in the context of breast/chest treatments using rigid phantoms. The system has an intrinsic uncertainty of +/- 1 mm; and when two systems in different rooms (CT and treatment room) are used for correlating positional information, the uncertainty is less than 2 mm.