Stiffness control of balance in quiet standing

Our goal was to provide some insights into how the CNS controls and maintains an upright standing posture, which is an integral part of activities of daily living. Although researchers have used simple performance measures of maintenance of this posture quite effectively in clinical decision making, the mechanisms and control principles involved have not been clear. We propose a relatively simple control scheme for regulation of upright posture that provides almost instantaneous corrective response and reduces the operating demands on the CNS. The analytic model is derived and experimentally validated. A stiffness model was developed for quiet standing. The model assumes that muscles act as springs to cause the center-of-pressure (COP) to move in phase with the center-of-mass (COM) as the body sways about some desired position. In the sagittal plane this stiffness control exists at the ankle plantarflexors, in the frontal plane by the hip abductors/adductors. On the basis of observations that the COP-COM error signal continuously oscillates, it is evident that the inverted pendulum model is severely underdamped, approaching the undamped condition. The spectrum of this error signal is seen to match that of a tuned mass, spring, damper system, and a curve fit of this "tuned circuit" yields omega n the undamped natural frequency of the system. The effective stiffness of the system, Ke, is then estimated from Ke = I omega n2, and the damping B is estimated from B = BW X I, where BW is the bandwidth of the tuned response (in rad/s), and I is the moment of inertia of the body about the ankle joint. Ten adult subjects were assessed while standing quietly at three stance widths: 50% hip-to-hip distance, 100 and 150%. Subjects stood for 2 min in each position with eyes open; the 100% stance width was repeated with eyes closed. In all trials and in both planes, the COP oscillated virtually in phase (within 6 ms) with COM, which was predicted by a simple 0th order spring model. Sway amplitude decreased as stance width increased, and Ke increased with stance width. A stiffness model would predict sway to vary as Ke-0.5. The experimental results were close to this prediction: sway was proportional to Ke(-0.55). Reactive control of balance was not evident for several reasons. The visual system does not appear to contribute because no significant difference between eyes open and eyes closed results was found at 100% stance width. Vestibular (otolith) and joint proprioceptive reactive control were discounted because the necessary head accelerations, joint displacements, and velocities were well below reported thresholds. Besides, any reactive control would predict that COP would considerably lag (150-250 ms) behind the COM. Because the average COP was only 4 ms delayed behind the COM, reactive control was not evident; this small delay was accounted for by the damping in the tuned mechanical system.     

Postural control--a comparison between patients with chronic anterior cruciate ligament insufficiency and healthy individuals

Postural control in the sagittal plane was evaluated in 22 patients with chronic anterior cruciate ligament (ACL) deficiency and the result was compared to that of a control group of 20 uninjured subjects. Measurement of the body sway was done on a fixed and sway-referenced force plate in both single-limb and two-limb stance, with the eyes open and closed, respectively. Further, an analysis of the postural reactions to perturbations backwards and forwards, respectively, was made in single-limb stance. The results demonstrated statistically significant deficits of the postural control in the patient group compared to the control group, but also within the patient group. There was a significantly higher body sway within the patient group when standing on a stable support surface on the injured limb than standing on the uninjured limb with the eyes open, but no difference with the eyes closed. When standing on a stable support surface, there was a significantly higher body sway in the patient group standing on the injured leg than in the control group, both with eyes open and closed. The patient group also showed a significantly impaired postural control compared to the control group when standing on the uninjured leg with the eyes closed. There was no difference between the groups in the two-limb stance. When standing on the sway-referenced support surface, the patient group had a significantly larger body sway than the control group when the eyes were open, but there was no significant difference between the groups with the eyes closed. The measurement of the postural corrective responses to perturbations backwards and forwards showed that the reaction time measured from the initiation of the force plate translation, and the amplitude of the body sway was significantly greater in the patient group than in the control group. We conclude that patients with a continuing chronic ACL insufficiency several years after injury have an impaired postural control in the antero-posterior direction in single-limb stance on their injured leg. They also show a greater body sway and a prolonged reaction time when subjected to antero-posterior perturbations when standing on their injured leg.     

Cooperative mechanisms between leg joints of Carausius morosus I. Nonspiking interneurons that contribute to interjoint coordination

Three nonspiking interneurons are described in this paper that influence the activity of the motor neurons of three muscles of the proximal leg joints of the stick insect. Interneurons were recorded and stained intracellularly by glass microelectrodes; motor neurons were recorded extracellularly with oil-hook electrodes. The motor neurons innervate the two subcoxal muscles, the protractor and retractor coxae, and the thoracic part of the depressor trochanteris muscle. The latter spans the subcoxal joint before inserting the trochanter, thus coupling the two proximal joints mechanically. The three interneurons are briefly described here. First, interneuron NS 1 was known to become more excited during the swing phase of the rear and the stance phase of the middle leg. When depolarized it excited several motor neurons of the retractor coxae. This investigation revealed that it inhibits the activity of protractor and thoracic depressor motor neurons when depolarized as well. In a pilocarpine-activated animal, the membrane potential showed oscillations in phase with the activity of protractor motor neurons, suggesting that NS 1 might contribute to the transition from swing to stance movement. Second, interneuron NS 2 inhibits motor neurons of protractor and thoracic depressor when depolarized. In both a quiescent and a pilocarpine-activated animal, hyperpolarizing stimuli excite motor neurons of both muscles via disinhibition. In one active animal the disinhibiting stimuli were sufficient to generate swing-like movements of the leg. In pilocarpine-activated preparations the membrane potential oscillated in correlation with the motor neuronal activity of the protractor coxae and thoracic depressor muscle. Hyperpolarizing stimuli induced or reinforced the protractor and thoracic depressor bursts and inhibited the activity of the motor neurons of the retractor coxae muscle, the antagonistic muscle of the protractor. Therefore interneuron NS 2 can be regarded as an important premotor interneuron for the switching from stance to swing and from swing to stance. Finally, interneuron NS 3 inhibits the spontaneously active motor neurons of both motor neuron pools in the quiescent animal. During pilocarpine-induced protractor bursts, depolarizing stimuli applied to the interneuron excited several protractor motor neurons with large action potentials and one motor neuron of the thoracic depressor. No oscillations of the membrane potentials were observed. Therefore this interneuron might contribute to the generation of rapid leg movements. The results demonstrated that the two proximal joints are coupled not only mechanically but also neurally and that the thoracic part of the depressor appears to function as a part of the swing-generating system.     

Reduction of rostral dorsal accessory olive responses during reaching

1. Rostral dorsal accessory olive (rDAO) neurons are sensitive to light touch but have little or no discharge during active movement. We hypothesize that sensitivity of the rDAO is reduced during movement. To test this hypothesis, we evaluated sensitivity of rDAO neurons as cats reached out and retrieved a handle. On selected trials, mechanical or electrical perturbations to the forelimb were presented, and responses of rDAO neurons to the disturbances were recorded. 2. All rDAO units were highly sensitive to somatosensory stimuli during periods of stance. The cells responded to stimuli such as touch to hairs or light taps to the platform on which the cat was standing. 3. Discharges of rDAO neurons showed little or no synchronization to any aspect of the reaching task. rDAO neurons failed to fire to mechanical perturbations of the food handle during retrieval or hold phases of the task, even when their receptive fields included the surface of the paw in contact with the handle. 4. Electrical stimulation of the skin produced the greatest evoked response at all rDAO recording sites when the cats were at stance. Stimulation at any time during the reaching task, including periods of holding and licking, produced lower-amplitude evoked responses. The reduction in evoked response could be large and was restricted to the limb performing the task. 5. The data support the hypothesis that the cutaneous sensitivity of the rDAO is reduced during behavior. However, the inhibition does not appear to be tailored to specific times during the task or to neurons with specific receptive field locations on the actively moving limb. The reduction in sensitivity is as likely to be dependent on limb posture as on movement. We conclude that the rDAO discharge provides the cerebellum with information about vibration or contact during stance; it does not provide reliable information about undisturbed or disturbed movement. Climbing fiber input from rDAO might be useful in the preparation to make a movement, but it is probably not useful for correction of movement errors.     

Responsiveness and reliability of a pediatric strategy score for balance

Various motor patterns or 'strategies' can be used to maintain balance. The purpose of this study was to determine the responsiveness of a pediatric strategy score (PED-SS) compared to a standard strategy score (SS) as a measure of age-related changes in the force patterns used to maintain stance. Eighty-one healthy children between 3-6 years of age were tested during stance on a force platform while facing a visual surround. The platform, visual surround (or both) moved simultaneously with the child's body sway. Four sensory conditions that altered visual and somatosensory (support surface) inputs were presented. The PED-SS was found to be more responsive to age-related changes in balance behavior compared to the SS. The oldest children (aged 5 and 6 years) showed the greatest ability to utilize horizontal A/P shear force to maintain stance and this finding was reflected only in the PED-SS. The implications of evaluating force strategy as one component of balance in healthy children is discussed with respect to the early developmental assessment of vestibular and developmental coordination disorders.     

Effect of physical training on head-hip co-ordinated movements during unperturbed stance

A cross-correlation analysis between head and hip lateral accelerations has been used to analyse the effects of sport training (in experts in judo or classical dance as compared to controls) on postural strategies during unperturbed stance. Subjects were standing in the sharpened Romberg position on either a hard or foam rubber support. The main results were: (1) several non-visual and ankle-like strategies (head-hip movements in the same sense) were used by both groups on both supports; (2) two types of lateral hip strategies (head-hip movements in opposite sense) were seen in controls on soft support only, and were mainly modulated by vision. Training appears to result in a shift from a visual to a proprioceptive dominance in the regulation of postural control in unperturbed stance.     

Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance

BACKGROUND: The effects of standing balance training on the ability to maintain stability in both static two-leg and one-leg stance were tested in healthy older adults. METHODS: Subjects (age range 65-90 years) were randomly assigned to a training (n = 12) or control group (n = 12). Training subjects received a 10-hour balance training program which selectively manipulated sensory inputs from the visual, vestibular, and somatosensory systems. RESULTS: Training subjects showed significantly improved stability (root-mean-square values of anteroposterior platform torque) after training in five of the eight training conditions (when somatosensory inputs were changed or when two or more sensory systems were simultaneously manipulated) (p < .006). When tested 4 weeks after completion of training, subjects (a) fell less frequently when the ankle/foot somatosensory inputs were minimized and (b) stood longer on one leg than the control group (p < .001). CONCLUSIONS: Balance training designed to improve intersensory interaction could effectively improve balance performance in healthy older adults.     

Rhabdomyosarcoma mimicking acute leukemia in an adult: report of a case with histologic, flow cytometric, cytogenetic, immunohistochemical, and ultrastructural studies

OBJECTIVES: To measure ground reaction force variables during lameness resulting from impaired tibial nerve function and to determine whether these variables changed significantly as recovery progressed. ANIMALS: 11 healthy Greyhounds of either sex, weighing between 22 and 39 kg. PROCEDURE: On 3 consecutive days before surgery, ground reaction forces were measured by force platform gait analysis at the trot. In dogs under general anesthesia, the left tibial nerve was crushed proximal to innervation of the gastrocnemius muscle. Gait analyses were repeated on days 8 to 10, 28 to 30, 43 to 45, 58 to 60, and 90 to 92 after surgery. Ground reaction force variables and stance time were compared among the 3-day clusters. RESULTS: 10 days after surgery, all dogs had weight-bearing lameness attributed to paralysis of muscles in the caudal compartment of the crus. Nerve regeneration resulted in functional recovery within 3 months. Decreases in vertical force were significant 10 days after surgery; thereafter, changes reflected gradual return of load bearing, with the most marked improvement between 10 and 45 days. At 90 days, vertical force variables were within 3% of presurgical values. Stance time for the left hind limb was significantly longer at 10, 30, and 45 days after surgery and was seen in all dogs, but returned to within 1 % of preoperative stance time at 90 days. The effect of tibial nerve dysfunction on braking or propulsive force was not significant. CONCLUSIONS AND CLINICAL RELEVANCE: The significant changes in vertical ground reaction forces in hind limbs of dogs during lameness that resulted from impaired tibial nerve function are detectable, as is response during recovery, by use of force platform analysis.     

Slow covariations in neuronal resting potentials can lead to artefactually fast cross-correlations in their spike trains

Slow covariations in neuronal resting potentials can lead to artefactually fast cross-correlations in their spike trains. J. Neurophysiol. 80: 3345-3351, 1998. A model of two lateral geniculate nucleus (LGN) cells, which interact only through slow (tens of seconds) covariations in their resting membrane potentials, is used here to investigate the effect of such covariations on cross-correlograms taken during stimulus-driven conditions. Despite the slow timescale of the interactions, the model generates cross-correlograms with peak widths in the range of 25-200 ms. These bear a striking resemblance to those reported in studies of LGN cells by Sillito et al., which were taken at the time as evidence of a fast spike timing synchronization interaction; the model highlights the possibility that those correlogram peaks may have been caused by a mechanism other than spike synchronization. Slow resting potential covariations are suggested instead as the dominant generating mechanism. How can a slow interaction generate covariogram peaks with a width 100-1,000 times thinner than its timescale? Broad peaks caused by slow interactions are modulated by the cells' poststimulus time histograms (PSTHs). When the PSTHs have thin peaks (e.g., tens of milliseconds), the cross-correlogram peaks generated by slow interactions will also be thin; such peaks are easily misinterpretable as being caused by fast interactions. Although this point is explored here in the context of LGN recordings, it is a general point and applies elsewhere. When cross-correlogram peak widths are of the same order of magnitude as PSTH peak widths, experiments designed to reveal short-timescale interactions must be interpreted with the issue of possible contributions from slower interactions in mind.     

Dislocation dissociation in some f.c.c. metals

The dissociation of a perfect screw dislocation into a stacking fault in an f.c.c. lattice is modeled by the modified lattice statics. The interatomic potentials are obtained from the work of Esterling and Swaroop and differ substantially from those empirical potentials usually employed in defect simulations. The calculated stacking fault widths for aluminum, copper, and silver are in good agreement with weak beam microscopy results.     

Involuntary movements and birth injuries to brain

OBJECTIVE: To evaluate the effect of using an optimally adjusted fixed ankle foot orthosis to control knee pain and promote improvement in gait parameters in a subject with hemiplegia following a traumatic brain injury 11 years previously. DESIGN: This is the report of a single case, using gait laboratory facilities to monitor force alignment relative to the knee and single leg balance time with the subject barefoot. SUBJECT: A 35-year-old woman with a right hemiplegia seen 11 years after onset. INTERVENTION: A polypropylene fixed ankle foot orthosis was supplied to the hemiplegic limb and shoe modifications were made to optimize the position of the ground reaction force relative to the knee during stance phase of gait. This orthosis was used on a daily basis for one year. RESULTS: Knee pain was controlled after three months use of the orthosis. Graphical results of force alignment during stance phase of gait are presented for initial assessment and at one and four years postorthotic supply. A large knee-extending effect was noted on the hemiplegic limb at initial assessment and this was reduced by 67% of its initial value at one year. A compensatory early heel lift was initially noted on the opposite limb and this was reduced by 42% of the initial height at one year. These results were maintained at four years. Right leg standing balance was not initially possible but was recorded as 5 s duration at three months and this was maintained at one and at four years. CONCLUSIONS: The use of an optimally adjusted ankle foot orthosis was effective in controlling knee pain and improving barefoot gait parameters with maintenance of the improvement after use of the orthosis was discontinued. Further research is required to fully establish the potential of this approach in subjects with traumatic brain injury.     

Sensory afferences and motor control of equilibrium using static and dynamic posture tests

One thousand two hundred posturographic tests have been performed since 1988 at the Laboratoire d'Exploration Fonctionnelle ORL, Centre Hospitalier Universitaire, Nancy-Brabois, using three complementary protocols (Toennis GmBh, G). Static tests [1] measure over 20 seconds periods the displacement of the center of foot pressure (CFP) on individual standing upright on the platform. Dynamic tests assess the mechanisms of balance control following measured platform movements, using surface EMG after a single sharp and unexpected tilt [2], or CFP displacements during longer regular oscillations of the platform [3]. The latter test enables an analysis of balance strategy adopted to maintain equilibrium. These three programs were applied to series of children, adults, elderly people, sportsmen, and patients suffering from ENT, neurological or traumatic disorders. They were confirmed to be complementary tests allowing a thorough investigation of all balance control mechanisms: visual afferences [1], somesthesy [2] and the combination of visual, somesthetic and vestibular afferences in the third test.     

Coupling of head and body movement with motion of the audible environment.

The authors asked whether standing posture could be controlled relative to audible oscillation of the environment. Blindfolded sighted adults were exposed to acoustic flow in a moving room, and were asked to move so as to maintain a constant distance between their head and the room. Acoustic flow had direct (source) and indirect (reflected) components. Participants exhibited strong coupling of postural motion with room motion, even when direct information about room motion was masked and was available only in reflected sound. Patterns of hip–ankle coordination closely resembled patterns observed in previous research involving coupling of sway with a visible moving room. The results demonstrate that blindfolded adults can control the dynamics of stance relative to motion of the audible environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Colourimetric point mutation assay: for detection of precore mutants of hepatitis B

Rats with unilateral dopamine (DA) depletions (hemiParkinson analogue rats) produced by intracerebral 6-hydroxydopamine injection are impaired in using the contralateral (bad) limbs for postural adjustments. This article examines whether the bad limbs are impaired in applying the forces required to initiate postural adjustments that anticipate and accompany voluntary movements. The rats were trained to reach for food using their good paw while standing on small platforms, each of which measured force changes produced by an individual limb. In one condition the force platforms were aligned to support the limb placement of normal rats and in the second they were aligned to permit the DA-depleted rats to use a compensatory reaching stance. It was found that the bad limbs of the DA-depleted rats produced normal supporting reactions but did not initiate adjustments in posture. Postural adjustments were initiated with the good limbs and preceded rather than accompanied the reaching movements. When constrained to use the posture of normal rats, the DA-deplete rats could not reach successfully, but when allowed to adjust their stance to increase reliance on the good limbs, reaching performance improved. Measures of ground reaction forces confirm that DA-depleted rats can support posture but cannot initiate postural adjustments with their impaired limbs.     

Forefoot deformity, pain, and mobility in rheumatoid and nonarthritic subjects

OBJECTIVE: To evaluate how painful metatarsal arthritis affects foot and ankle mechanics and mobility. METHODS: We studied 16 symptomatic forefeet in 10 patients with rheumatoid arthritis (RA) and compared them with 14 asymptomatic forefeet in 7 nonarthritic subjects. RA limbs with significant disease at other locations were excluded. We measured pain and deformity of the foot using a visual analog scale and a modified articular index. A video based 3 dimensional gait analysis system and force platform were used to collect data on subjects walking barefoot at a self-selected pace according to an established protocol. Mobility level was quantified using the Sickness Impact Profile (SIP) ambulation subscale. RESULTS: We observed considerable pain and deformity of the forefeet of RA subjects. During gait, motion and force measures revealed that RA subjects significantly (p < 0.005) delayed and reduced forefoot loading, which minimized use of the foot as a rigid level for push off. As a result, stride lengths were shorter and gait was slower compared to nonarthritic subjects. SIP scores revealed that these changes in gait resulted in moderate disability in RA subjects (p=0.05). CONCLUSION: Impairments of the forefoot due to RA include pain and deformity, which produce characteristic stance phase abnormalities in foot function, a slow walking speed, and moderate disability.     

Random association among alleles in clonal populations of Sclerotinia sclerotiorum

A long standing goal in protein structure studies is the development of reliable energy functions that can be used both to verify protein models derived from experimental constraints as well as for theoretical protein folding and inverse folding computer experiments. In that respect, knowledge-based statistical pair potentials have attracted considerable interests recently mainly because they include the essential features of protein structures as well as solvent effects at a low computing cost. However, the basis on which statistical potentials are derived have been questioned. In this paper, we investigate statistical pair potentials derived from protein three-dimensional structures, addressing in particular questions related to the form of these potentials, as well as to the content of the database from which they are derived. We have shown that statistical pair potentials depend on the size of the proteins included in the database, and that this dependence can be reduced by considering only pairs of residue close in space (i.e., with a cutoff of 8 A). We have shown also that statistical potentials carry a memory of the quality of the database in terms of the amount and diversity of secondary structure it contains. We find, for example, that potentials derived from a database containing alpha-proteins will only perform best on alpha-proteins in fold recognition computer experiments. We believe that this is an overall weakness of these potentials, which must be kept in mind when constructing a database.     

Force and motion analysis of the normal, diseased, and prosthetic ankle joint

A 2-dimensional motion and force study of the ankle joint during gait has been carried out on normal subjects and patients with ankle joint disease, before and 1 year following total ankle replacemetn. The methods employed involved the use of high-speed motion picture film, force plate and foot-switch data. The Achilles and anterior tibial tendon forces, the compressive and tangential (shear) forces across the ankle during stance phase of gait were determined, based on a quasi-static analysis. During stance phase of gait normal subjects used a mean of 24.4 degree of sagittal plane ankle motion. Patients with ankle joint disease showed reduced motion which returned to near normal values 1 year following total ankle replacement. Compressive force across the ankle joint rose to about 5 times body weight during the latter part of stance phase. Backward, or aft, shear forces or nearly full body weight were demonstrated during all but the last 20% of stance phase. Patients with ankle joint disease apparently altered their gait to markedly reduce these forces. Following total ankle replacement, shear forces returned toward more normal values, but compressive forces were not significantly changed.     

Taking on managed care: One reviewer at a time.

The ethical standing of the managed care reviewer who would make determinations of medical necessity in mental health practice is called into question. The ethical standards governing each of the major mental health professions are reviewed in reference to this activity. Each profession has provisions in its standards suggesting that such utilization review of psychotherapy is, at least, of questionable ethical standing. The author describes his personal effort to hold each reviewer to account for these alleged breaches of professional ethics. A recommendation is made for the ethics officers of the respective mental health professions, in concert, to make explicit their respective professions' stance against such ethical misconduct when their members engage in such review. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peripheral neuropathy effect on ankle inversion and eversion detection thresholds

A servo-controlled foot platform was used to quantify, in upright stance, the thresholds for sensing ankle inversion and eversion movements in seven geriatric patients with peripheral neuropathy (PN) confirmed by nerve conduction studies and seven age- and gender-matched (C) controls with normal nerve conduction function. The PN group had a 4.6-fold larger (p = 0.0026) threshold (mean [SD] 1.37 [1.74]degrees) for perceiving the presence and direction of an ankle rotation at a 75% rate of success (TH75) than did the C group (0.3[0.17]degrees). Inversion acuity was approximately twice that of eversion acuity in both groups. The PN group demonstrated better proprioceptive acuity in unipedal stance than in bipedal stance, whereas no such difference was found in the C group. Semiquantitative clinical tests of PN group proprioception at the ankle performed in the seated position failed to demonstrate significant differences from controls save in one case; however, the results of such tests at the toe were abnormal in all patients. In the geriatric population, PN is associated with deficits in ankle proprioception known theoretically to hamper maintenance of unipedal balance. It is significant that these deficits are associated with a clinically demonstrable loss of position sense at the toe but not the ankle.