Anticipatory postural adjustments and the latency of compensatory stepping reactions in humans

A compensatory stepping response is a commonly used strategy in recovering balance control after a postural perturbation. Unlike gait initiation, the compensatory stepping often occurs without an anticipatory postural adjustment (APA), in which body weight is shifted to the swing leg first and then back to the stance leg prior to foot lifting. In postural perturbation studies using a moving platforms stepping responses without an APA were found to have shorter latency to foot lifting than trials with an APA. We studied stepping responses of healthy young adults under postural perturbation of a pulling force impulse on the subject's waist. In contrast to previous studies, the latency of foot lifting was found in the current study to be shorter in the trials with an APA than trials without an APA. Furthermore, greater amplitude of an APA was associated with a shorter latency of foot lifting. Response with an APA of large amplitude may indicate high level of determinant for foot lifting. A pause as to whether or not to initiate/complete a stepping response is suggested to be partially the cause of delayed foot lifting in trials without an APA or with small amplitude of the APA.     

External postural perturbations induce multiple anticipatory postural adjustments when subjects cannot pre-select their stepping foot

Previous research on human balance recovery suggests that, prior to an externally triggered postural perturbation, healthy subjects can pre-select their postural response based on the environmental context, but it is unclear whether this pre-selection includes the selection of a stepping leg when performing compensatory steps. We sought to determine how pre-selecting a stepping limb affects the compensatory steps and stability of young, healthy subjects when responding to postural perturbations. Nine healthy subjects (24–37 years of age) stepped in response to backward translations of a platform under their feet when, prior to the perturbations, the subjects either knew whether they were to step with their left or right leg to a visual target (the Predictable condition) or did not know whether to step with their left or right leg until one of two targets appeared at perturbation onset (the Unpredictable condition). The Unpredictable condition also included randomly inserted trials of toes-up rotations and backward translations without targets (catch trials). The results showed that, in the Predictable condition, the subjects consistently exhibited one anticipatory postural adjustment (APA; a lateral weight shift toward the stance limb) before stepping accurately to the target with the correct leg. In the Unpredictable condition, the subjects either (1) exhibited multiple APAs, late step onsets, and forward center-of-mass (CoM) displacements that were farther beyond their base of support, or (2) exhibited an early step with only one APA and kept their CoM closer to the base of support, but also stepped more often with the incorrect leg. Thus, when the subjects had to select a stepping leg at perturbation onset, they either became more unstable and used multiple APAs to delay stepping in order to provide enough time to select the correct stepping leg, or they stepped earlier to remain stable but often stepped with the incorrect leg. In addition, responses to catch trials in the Unpredictable condition included distorted step placements that resembled steps to anticipated targets, despite allowing the subjects to step with a leg of their choice and to a location of their choice. Lastly, the subjects’ voluntary stepping latencies to visual targets presented without perturbations were twice as long as their stepping latencies to the backward platform translations. Therefore, healthy subjects appear to pre-select their stepping limb, even when the perturbation characteristics are unpredictable, because relying on visual input provided at perturbation onset requires a delayed response that leads to greater instability.     

A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance

People with a history of low back pain (LBP) exhibit altered responses to postural perturbations, and the central neural control underlying these changes in postural responses remains unclear. To characterize more thoroughly the change in muscle activation patterns of people with LBP in response to a perturbation of standing balance, and to gain insight into the influence of early- vs. late-phase postural responses (differentiated by estimates of voluntary reaction times), this study evaluated the intermuscular patterns of electromyographic (EMG) activations from 24 people with and 21 people without a history of chronic, recurrent LBP in response to 12 directions of support surface translations. Two-factor general linear models examined differences between the 2 subject groups and 12 recorded muscles of the trunk and lower leg in the percentage of trials with bursts of EMG activation as well as the amplitudes of integrated EMG activation for each perturbation direction. The subjects with LBP exhibited 1) higher baseline EMG amplitudes of the erector spinae muscles before perturbation onset, 2) fewer early-phase activations at the internal oblique and gastrocnemius muscles, 3) fewer late-phase activations at the erector spinae, internal and external oblique, rectus abdominae, and tibialis anterior muscles, and 4) higher EMG amplitudes of the gastrocnemius muscle following the perturbation. The results indicate that a history of LBP associates with higher baseline muscle activation and that EMG responses are modulated from this activated state, rather than exhibiting acute burst activity from a quiescent state, perhaps to circumvent trunk displacements.     

Movement of the lumbar spine is critical for maintenance of postural recovery following support surface perturbation

Repeated measures design. This study examined recovery of postural equilibrium (centre of pressure (COP) excursion, time to recover balance, and the number of postural adjustments) following unexpected support surface perturbation in healthy participants with and without a rigid lumbar corset to reduce lumbar motion. Lumbar spine movement is thought to aid postural stability, especially when a “hip” (lumbopelvic) strategy is required, such as in response to large and fast perturbations. Delayed onset of lumbar spine movement in association with prolonged postural recovery in chronic low back pain implies reduced spinal motion could underpin balance deficits in this group. However, other explanations such as poor proprioception cannot be excluded, and the relationship between lumbar movement and postural stability remains unclear. We hypothesized restricted lumbar spine movement would impair control of postural recovery following support surface perturbation. Participants regained postural stability following unexpected support surface perturbations in different directions (forward and backward), with different amplitudes (small, medium, and large), with and without restriction of spine motion by a hard lumbar corset. Although the latency of the postural adjustment was unaffected by the corset, the quality of postural recovery was compromised (increased COP range, time taken for postural recovery, and number of postural adjustments) during recovery, especially in response to large perturbation. Restriction of lumbar spine movement adversely affects postural recovery. The results suggest movement of the lumbar spine, although small in amplitude, is critical for efficient recovery of standing balance.     

Common muscle synergies for control of center of mass and force in nonstepping and stepping postural behaviors

We investigated muscle activity, ground reaction forces, and center of mass (CoM) acceleration in two different postural behaviors for standing balance control in humans to determine whether common neural mechanisms are used in different postural tasks. We compared nonstepping responses, where the base of support is stationary and balance is recovered by returning CoM back to its initial position, with stepping responses, where the base of support is enlarged and balance is recovered by pushing the CoM away from the initial position. In response to perturbations of the same direction, these two postural behaviors resulted in different muscle activity and ground reaction forces. We hypothesized that a common pool of muscle synergies producing consistent task-level biomechanical functions is used to generate different postural behaviors. Two sets of support-surface translations in 12 horizontal-plane directions were presented, first to evoke stepping responses and then to evoke nonstepping responses. Electromyographs in 16 lower back and leg muscles of the stance leg were measured. Initially (～100-ms latency), electromyographs, CoM acceleration, and forces were similar in nonstepping and stepping responses, but these diverged in later time periods (～200 ms), when stepping occurred. We identified muscle synergies using non-negative matrix factorization and functional muscle synergies that quantified correlations between muscle synergy recruitment levels and biomechanical outputs. Functional muscle synergies that produce forces to restore CoM position in nonstepping responses were also used to displace the CoM during stepping responses. These results suggest that muscle synergies represent common neural mechanisms for CoM movement control under different dynamic conditions: stepping and nonstepping postural responses.     

Human automatic postural responses: responses to horizontal perturbations of stance in multiple directions

Summary The effect of the direction of unexpected horizontal perturbations of stance on the organization of automatic postural responses was studied in human subjects. We recorded EMG activity from eight proximal and distal muscles acting on joints of the legs and hip known to be involved in postural corrections, while subjects stood on an hydraulic platform. Postural responses to horizontal motion of the platform in 16 different directions were recorded. The amplitude of the EMG responses of each muscle studied varied continuously as perturbation direction was changed. The directions for which an individual muscle showed measurable EMG activity were termed the muscle's angular range of activation. There were several differences in the response characteristics of the proximo-axial muscles as opposed to the distal ones. Angular ranges of activity of the distal muscles were unipolar and encompassed a range of less than 180°. These muscles responded with relatively constant onset latencies when they were active. Proximo-axial muscles, acting on the upper leg and hip showed larger angular ranges of activation with bimodal amplitude distributions and/ or onset latency shifts as perturbation direction changed. While there were indications of constant temporal relationships between muscles involved in responses to perturbations around the sagittal plane, the onset latency relationships for other directions and the response amplitude relationships for all directions varied continuously as perturbation direction was changed. Responses were discrete in that for any particular perturbation direction there appeared to be a single unique response. Thus, while the present results do not refute the hypothesis that automatic postural responses may be composed of mixtures of a few elemental synergies, they suggest that composition of postural responses is a complex process that includes perturbation direction as a continuous variable.     

Practice modifies the developing automatic postural response

 The purpose of this study was to examine effects of experience with a postural task on components of the automatic postural response including: (1) probability of activation of functionally appropriate postural muscles; (2) number of functionally appropriate postural muscles activated; and (3) onset latencies of functionally appropriate postural muscles in infants. Infants (n=15; age 36–48 weeks old) able to pull themselves into a standing position but not able to walk independently were tested using a postural task requiring the infant to stand and balance, with support, following a forward or backward movement of the support surface (platform perturbation). Infants were tested twice at 5-day intervals. One-half of the infants, the training group, were given intense platform perturbation training on the days between test sessions. Infants in the second group were also brought into the laboratory on the days between test sessions but were not exposed to platform perturbations during those days. Electromyograms of six leg and trunk muscles were recorded during test sessions to provide muscle onset latencies, probability of muscle activation data, and the number of postural muscles activated following a perturbation. Training infants demonstrated significant increases in probability of activating functionally appropriate muscles with tibialis anterior, quadriceps, and abdominal muscles activated in response to backward sway and gastrocnemius muscle in response to forward sway. The number of functionally appropriate postural muscles activated in a single trial also increased in the training group. There were no significant changes in mean postural muscle onset latencies or number of trials with antagonist muscle coactivation for either training or control groups. These findings suggest that during development selective parameters of the automatic postural response are affected by experience with the postural task. Received: 30 November 1996 / Accepted: 12 September 1996     

Control of reactive balance adjustments in perturbed human walking: roles of proximal and distal postural muscle activity

Studies on the proactive control of gait have shown that proximal (hip/trunk) muscles are the primary contributors to balance control, while studies on reactive balance control during perturbed gait, examining only activity in distal (leg/thigh) muscles, have shown that these muscles are important in compensating for a gait disturbance. This study tested the hypothesis that proximal muscles are also primary contributors to reactive balance control during perturbed gait. Thirty-three young adults participated in a study in which an anterior slip was simulated at heel strike by the forward displacement of a force plate on which they walked. Surface electromyographic data were recorded from bilateral leg, thigh, hip and trunk muscles. Kinematic data were collected on joint angle changes in response to the perturbation. The results did not support the hypothesis that the proximal muscles contribute significantly to balance control during perturbed gait. The proximal muscles did not demonstrate more consistent activation, earlier onset latency, longer burst duration or larger burst magnitude than distal muscles. Moreover, although proximal postural activity was often present in the first slip trial, it tended to adapt away in later trials. By contrast, the typical postural responses exhibited by young adults consisted of an early (90–140 ms), high-magnitude (4–9 times muscle activity during normal walking) and relatively long duration (70–200 ms) activation of bilateral anterior leg muscles as well as the anterior and posterior thigh muscles. Thus, postural activity from bilateral leg and thigh muscles and the coordination between the two lower extremities were the key to reactive balance control and were sufficient for regaining balance within one gait cycle. The adaptive attenuation of proximal postural activity over repeated trials suggests that the nervous system overcompensates for a novel balance threat in the first slip trial and fine-tunes its responses with experience. Received: 24 March 1997 /Accepted: 4 September 1997     

A limited set of muscle synergies for force control during a postural task

Recently developed computational techniques have been used to reduce muscle activation patterns of high complexity to a simple synergy organization and to bring new insights to the long-standing degrees of freedom problem in motor control. We used a nonnegative factorization approach to identify muscle synergies during postural responses in the cat and to examine the functional significance of such synergies for natural behaviors. We hypothesized that the simplification of neural control afforded by muscle synergies must be matched by a similar reduction in degrees of freedom at the biomechanical level. Electromyographic data were recorded from 8-15 hindlimb muscles of cats exposed to 16 directions of support surface translation. Results showed that as few as four synergies could account for >95% of the automatic postural response across all muscles and all directions. Each synergy was activated for a specific set of perturbation directions, and moreover, each was correlated with a unique vector of endpoint force under the limb. We suggest that, within the context of active balance control, postural synergies reflect a neural command signal that specifies endpoint force of a limb.     

The Balance Recovery Mechanisms Against Unexpected Forward Perturbation

Falls are one of the main concerns of the elderly. Proper postural adjustments to maintain balance involve the activation of appropriate muscles to produce force and to relocate the center of body mass (CoM). In this study, biomechanical aspects of dynamic postural responses against forward perturbations were experimentally determined by simultaneous measurements of joint angles and EMG activations. Thirteen young and healthy volunteers took turns standing on a flat platform, and were directed to move in the forward direction by an AC servo-motor set at two different speeds (0.1 and 0.2 m/s). Joint motions were recorded, and they followed the sequence of ankle dorsiflexion, knee flexion, and then hip flexion during the later acceleration phase (AP) in order to maintain postural balance against forward perturbation. Tibialis anterior for the ankle dorsiflexion and biceps femoris for the knee flexion were activated during the second half of the AP as the primary muscles to recover balance. In addition, gastrocnemius, which was related to ankle plantarflexion, and rectus femoris, which was related to knee extension, were activated to maintain balance. Movements of the center of plantar pressure and ground reaction forces in fast-speed perturbation were significantly larger than those in slow-speed perturbation. As a result, the ankle strategy was used for slow-speed perturbation, but the mixed strategy consisting of both ankles and hip were used for fast-speed perturbation.     

Balance recovery from a forward fall: Developmental aspects of sensorimotor organization and the role of supraspinal control

We used the forward fall paradigm to test two hypotheses namely, that a supraspinal long-loop neural pathway is involved in the compensatory response, and secondly that the neural circuits underlying the performance of a balance-challenging task that requires the sequencing of several motor programs (compensatory reactions and stepping to recover balance) matures late in childhood. The first hypothesis was supported by the findings that the responses occurred earlier when the triggering signal was moved from the abdominal up to the chest level. The time required to react to the triggering signal within the supraspinal structures was also longer in children. The second hypothesis was verified by the observation of persisting soleus–tibialis coactivation in children up to 14 years old in three experimental conditions: unexpected release of the fall, voluntary release of the fall and longitudinal testing. These results suggest that the central processes involved in sequencing the postural responses do not mature until mid-adolescence. The maturation continues throughout childhood, with progressive emphasis on the central long- rather than short-latency pathways.     

Dynamic posturography in Parkinson's disease: diagnostic utility of the “first trial effect”

Previous dynamic posturography studies demonstrated clear abnormalities in balance responses in Parkinson's disease (PD) patients compared to controls at the group level, but its clinical value in the diagnostic process and fall risk estimation in individual patients leaves for improvement. Therefore, we investigated whether a new approach, focusing on the balance responses to the very first and fully unpractised trial rather than a pooled mean response to a series of balance perturbations, could further improve the diagnostic utility of dynamic posturography. Following the first trial, subjects were exposed to repeated balance perturbations, which also permitted us to investigate the training responses. Fourteen patients with PD and 18 age-matched controls were enrolled, who received a series of multidirectional postural perturbations, induced by support surface rotations. We measured trunk and upper arm kinematics and electromyographic responses, and evaluated group differences at three levels: the postural response to the very first backward perturbation; pooled first and habituated postural responses; and habituation rates. Analysis of the first trial responses yielded similar results as evaluation of the mean response over trials: forward flexion of the trunk induced by backward perturbations was decreased in patients, accompanied by increased muscle responses present. Moreover, trunk movement and muscle activity were equally present in both groups—suggesting a preserved training response in PD patients. Early masseter activity in both groups might be indicative of a startle-like component to the balance response. In terms of diagnostic utility, focusing on the first trial response or habituation rate is no better than analysis of pooled responses to a series of perturbations. The apparently preserved training response in PD patients suggests that balance reactions in PD can be improved by repeated exposure, and this may have implications for future exercise studies. Early masseter activity warrants further studies to evaluate a potential startle component in the pathophysiology of balance disorders.     

Scaling anticipatory postural adjustments dependent on confidence of load estimation in a bi-manual whole-body lifting task

Anticipatory control of motor output enables fast and fluent execution of movement. This applies also to motor tasks in which the performance of movement brings about a disturbance to balance that is not completely predictable. For example, in bi-manual lifting the pick-up of a load causes a forward shift of the centre of mass with consequent disturbance of posture. Anticipatory postural adjustments are scaled to the expected magnitude of the perturbation and are initiated well before the availability of sensory information characterising the full nature of the postural disturbance. However, when the postural disturbance unexpectedly changes, the anticipatory adjustment of joint torques is not equilibrated and may result in a disturbance to balance. In a previous study, it was demonstrated that apart from anticipatory postural adjustments, corrective responses after load pick-up are used to further compensate the postural disturbance. In this study it was examined whether the central nervous system (CNS) assembles a strategy that incorporates both anticipatory control and corrective responses, in which the magnitude of the anticipatory postural adjustments depends on the perceived level of predictability of the postural disturbance. Subjects performed series of lifts in which the magnitude of the load was never revealed to the subject. Two boxes equal in size and colour, but different in mass (6 and 16 kg), were used. Differences in expectation were created by several lifts with the 16-kg load before the 6-kg box was presented. It was observed that the number of strong corrective responses (stepping) varied with the number of 16-kg trials that formed the prior experience when the final 6-kg trial was presented. The follow-up question was whether control relied more on anticipation in the stepping trials, compared with trials in which such gross signs of imbalance were absent. In this study it was shown that subjects when stepping (i) exhibited differential anticipatory postural adjustments in comparison with 6-kg trials in which expectation was not shaped by preceding 16-kg trials, and (ii) scaled the anticipatory postural adjustments similar to those preceding lift-off of the 16-kg trial preceding it. These findings emphasise the programmed nature of the anticipatory postural adjustments and the ability of the CNS to selectively tune the anticipatory postural adjustments to stored information gained during the previous lift(s). Received: 30 October 1995 / Accepted: 10 September 1997     

Influence of postural anxiety on postural reactions to multi-directional surface rotations

Previous studies have shown significant effects of increased postural anxiety in healthy young individuals when standing quietly or performing voluntary postural tasks. However, little is known about the influence of anxiety on reactive postural control. The present study examined how increased postural anxiety influenced postural reactions to unexpected surface rotations in multiple directions. Ten healthy young adults (mean age: 25.5 yr, range: 22-27 yr) were required to recover from unexpected rotations of the support surface (7.5 degrees amplitude, 50 degrees/s velocity) delivered in six different directions while standing in a low postural threat (surface height: 60 cm above ground) or high postural threat (surface height: 160 cm above ground) condition. Electromyographic data from 12 different postural leg, hip, and trunk muscles was collected simultaneously. Full body kinematic data were also used to determine total body center of mass (COM) and segment displacements. Four distinct changes were observed with increased postural anxiety: increased amplitude in balance-correcting responses (120-220 ms) in all leg, trunk, and arm muscles; decreased onset latency of deltoid responses; reduced magnitude of COM displacement; and reduced angular displacement of leg, pelvis, and trunk. These observations suggest that changes in dynamic postural responses with increased anxiety are mediated by alterations in neuro-muscular control mechanisms and thus may contribute significantly to the pathophysiology of balance deficits associated with aging or neurological disease.     

Gaze behavior governing balance recovery in an unfamiliar and complex environment

Visuospatial information regarding obstacles and other environmental constraints on limb movement is essential for the successful planning and execution of stepping movements. Visuospatial control strategies used during gait and volitional stepping have been studied extensively; however, the visuospatial strategies that are used when stepping rapidly to recover balance in response to sudden postural perturbation are not well established. To study this, rapid forward stepping reactions were evoked by unpredictable support-surface acceleration while subjects stood amid multiple obstacles that moved intermittently and unpredictably prior to perturbation onset (PO). To prevent predictive control, subjects performed only one trial (their very first exposure to the perturbation and environment). Visual scanning of the obstacles and surroundings occurred prior to PO in all subjects; however, gaze was never redirected at the obstacles, step foot or landing site in response to the perturbation. Surprisingly, the point of gaze at time of foot-contact was consistently and substantially anterior to the step-landing site. Despite the apparent absence of ‘online’ visual feedback related to the foot movement, the compensatory step avoided obstacle contact in 10 of 12 young adults and 9 of 10 older subjects. The results indicate that the balance-recovery reaction was typically modulated on the basis of visuospatial environmental information that was acquired and continually updated prior to perturbation, as opposed to a strategy based on ‘online’ visual control. The capacity to do this was not adversely affected by aging, despite a tendency for older subjects to look downward less frequently than young adults.     

Vestibular influences on human postural control in combinations of pitch and roll planes reveal differences in spatiotemporal processing

The present study examined the influence of bilateral peripheral vestibular loss (BVL) in humans on postural responses to multidirectional surface rotations in the pitch and roll planes. Specifically, we examined the effects of vestibular loss on the directional sensitivity, timing, and amplitude of early stretch, balance correcting, and stabilizing reactions in postural leg and trunk muscles as well as changes in ankle torque and trunk angular velocity following multidirectional rotational perturbations of the support surface. Fourteen normal healthy adults and five BVL patients stood on a dual axis rotating platform which rotated 7.5° at 50°/s through eight different directions of pitch and roll combinations separated by 45°. Directions were randomized within a series of 44 perturbation trials which were presented first with eyes open, followed by a second series of trials with eyes closed. Vestibular loss did not influence the range of activation or direction of maximum sensitivity for balance correcting responses (120–220 ms). Response onsets at approximately 120 ms were normal in tibialis anterior (TA), soleus (SOL), paraspinals (PARAS), or quadriceps muscles. Only SOL muscle activity demonstrated a 38- to 45-ms delay for combinations of forward (toe-down) and roll perturbations in BVL patients. The amplitude of balance correcting responses in leg muscles between 120 and 220 ms was, with one exception, severely reduced in BVL patients for eyes open and eyes closed conditions. SOL responses were decreased bilaterally for toe-up and toe-down perturbations, but more significantly reduced in the downhill (load-bearing) leg for combined roll and pitch perturbations. TA was significantly reduced bilaterally for toe-up perturbations, and in the downhill leg for backward roll perturbations. Forward perturbations, however, elicited significantly larger TA activity in BVL between 120 and 220 ms compared to normals, which would act to further destabilize the body. As a result of these changes in response amplitudes, BVL patients had reduced balance correcting ankle torque between 160 and 260 ms and increased torque between 280 and 380 ms compared to normals. There were no differences in the orientation of the resultant ankle torque vectors between BVL and normals, both of which were oriented primarily along the pitch plane. For combinations of backward (toe-up) and roll perturbations BVL patients had larger balance correcting and stabilizing reactions (between 350 and 700 ms) in PARAS than normals and these corresponded to excessive trunk pitch and roll velocities. During roll perturbations, trunk velocities in BVL subjects after 200 ms were directed along directions different from those of normals. Furthermore, roll instabilities appeared later than those of pitch particularly for backward roll perturbations. The results of the study show that combinations of roll and pitch surface rotations yield important spatiotemporal information, especially with respect to trunk response strategies changed by BVL which are not revealed by pitch plane perturbations alone. Our results indicate that vestibular influences are earlier for the pitch plane and are directed to leg muscles, whereas roll control is later and focused on trunk muscles. Electronic Publication     

Adaptive control of gait stability in reducing slip-related backward loss of balance

The properties of adaptation within the locomotor and balance control systems directed towards improving one’s recovery strategy for fall prevention are not well understood. The purpose of this study was to examine adaptive control of gait stability to repeated slip exposure leading to a reduction in backward loss of balance (and hence in protective stepping). Fourteen young subjects experienced a block of slips during walking. Pre- and post-slip onset stability for all slip trials was obtained as the shortest distance at touchdown (slipping limb) and lift-off (contralateral limb), respectively, between the measured center of mass (COM) state, that is, position and velocity relative to base of support (BOS) and the mathematically predicted threshold for backward loss of balance. An improvement in pre- and post-slip onset stability correlated with a decrease in the incidence of balance loss from 100% (first slip) to 0% (fifth slip). While improvements in pre-slip stability were affected by a proactive anterior shift in COM position, the significantly greater post-slip onset improvements resulted from reductions in BOS perturbation intensity. Such reactive changes in BOS perturbation intensity resulted from a reduction in the demand on post-slip onset braking impulse, which was nonetheless influenced by the proactive adjustments in posture and gait pattern (e.g., the COM position, step length, flat foot landing and increased knee flexion) prior to slip onset. These findings were indicative of the maturing process of the adaptive control. This was characterized by a shift from a reliance on feedback control for postural correction to being influenced by feedforward control, which improved pre-slip stability and altered perturbation intensity, leading to skateover or walkover (>0.05 m or <0.05 m displacement, respectively) adaptive strategies. Finally, the stability at contralateral limb lift-off was highly predictive of balance loss occurrence and its subsequent rapid reduction, supporting the notion of the internal representations of stability limits that could be modified and updated, as a key component in the adaptive control.     

A novel approach in objective assessment of functional postural responses during fall-free perturbed standing in clinical environment.

The proposed approach offers few novelties in integration of objective assessment of postural responses when an unexpected perturbation is applied to the standing person into the existing rehabilitation therapy. The research apparatus was equipped with electrical actuators to provide unexpected perturbations (controllable and repeatable strength and duration) to the standing frame in eight directions during quiet standing in a fall-safe environment. During the perturbations ground reaction forces were recorded under each foot and the motion of center of pressure was derived to extract the postural response indicators in time and space domain. Seven neurologically intact subjects participated in normative set up that was used to develop an algorithm for selective postural response characteristics analysis for each perturbation direction. The postural responses in two incomplete spinal cord injured persons and hemiparetic stroke patient were investigated and contrasted to the normative responses to test the proposed approach. The outcomes of the investigation showed expected distinctive direction-dependent postural responses characteristic for hemiparetic subjects. Our observations suggest that the approach may become effective in substantial quantitative multidirectional stabilometric evaluation of functional postural responses, especially when the effectiveness of the balance training rehabilitation program is in need for objective evaluation. Simultaneously the apparatus can be used also for the balance training and therefore become a training and assessment tool for clinical and home environment.     

Abnormal force patterns for multidirectional postural responses in patients with Parkinson’s disease

This study tests the hypothesis that the basal ganglia are involved in optimizing postural responses for changes in perturbation direction and stance width. We compared the patterns of horizontal and vertical ground reactive forces under each leg in response to eight directions of surface translation in Parkinsons disease (PD) subjects and age-matched control subjects standing with both narrow and wide stance. Although passive reactive forces were larger, active forces were weaker and in abnormal directions for subjects with PD. Unlike the control subjects, who corrected their postural equilibrium in response to lateral and diagonal-lateral perturbations primarily with their loaded limbs, the PD subjects used both legs more symmetrically to recover equilibrium. PD subjects also did not change the magnitude or direction of reactive forces when initial stance width changed. These results support the hypothesis that the basal ganglia are important for optimizing automatic postural response patterns for changes in perturbation direction and for initial stance conditions.     

Automatic postural responses in the cat: responses of hindlimb muscles to horizontal perturbations of stance in multiple directions

Summary The effect of the direction of unexpected horizontal perturbations of stance on the organization of automatic postural responses was studied in cats. We recorded EMG activity in eight proximal and distal muscles of the hindlimb along with vertical forces imposed by the limbs in awake behaving cats while they stood on an hydraulic platform. Postural responses to motion of the platform in 16 different horizontal directions were recorded. Vertical force changes were consistent with passive shifts of the center of mass and active correction of stance by the animals. When the perturbation was in the sagittal plane, vertical force changes began about 65 ms following initial platform movement. When the perturbation contained a component in the lateral direction, latency for vertical force changes was about 25 ms and an inflection in the vertical force trace was observed at 65 ms. No EMG responses were observed with latencies that were short enough to account for the early force component and it was concluded that this force change was due to passive shifts of the center of mass. The amplitude of the EMG responses of each muscle recorded varied systematically as perturbation direction changed. The directions for which an individual muscle showed measurable EMG activity were termed the muscle's angular range of activation. No angular range of activation was oriented strictly in the A-P or lateral directions. Most muscles displayed angular ranges of activation that encompassed a range of less than 180°. Onset latencies of EMG responses also varied systematically with perturbation direction. The amplitude and latency relationships between muscles, which made up the organization of postural responses, also varied systematically as perturbation direction was changed. This result suggests that direction of perturbation determines organizational makeup of postural responses, and for displacements in the horizontal plane, is considered a continuous variable by the nervous system.