Lower limb joint-specific contributions to standing postural sway in persons with unilateral lower limb loss

BackgroundIndividuals with lower limb loss are at an increased risk for falls, likely due to impaired balance control. Standing balance is typically explained by double- or single-inverted pendulum models of the hip and/or ankle, neglecting the knee joint. However, recent work suggests knee joint motion contributes toward stabilizing center-of-mass kinematics during standing balance.Research QuestionTo what extent do hip, knee, and ankle joint motions contribute to postural sway in standing among individuals with lower limb loss?MethodsForty-two individuals (25 m/17f) with unilateral lower limb loss (30 transtibial, 12 transfemoral) stood quietly with eyes open and eyes closed, for 30 s each, while wearing accelerometers on the pelvis, thigh, shank, and foot. Triaxial inertial measurement units were transformed to inertial anterior-posterior components and sway parameters were computed: ellipse area, root-mean-square, and jerk. A state-space model with a Kalman filter calculated hip, knee, and ankle joint flexion-extension angles and ranges of motion. Multiple linear regression predicted postural sway parameters from intact limb joint ranges of motion, with BMI as a covariate (p < 0.05).ResultsWith eyes open, intact limb hip flexion predicted larger sway ellipse area, whereas hip flexion and knee extension predicted larger sway root-mean-square, and hip flexion, knee extension, and ankle plantarflexion predicted larger sway jerk. With eyes closed, intact limb hip flexion remained the predictor of sway ellipse area; no other joint motions influenced sway parameters in this condition.SignificanceHip, knee, and ankle motions influence postural sway during standing balance among individuals with lower limb loss. Specifically, increasing intact-side hip flexion, knee extension, and ankle plantarflexion motion increased postural sway. With vision removed, a re-weighting of lower limb joint sensory mechanisms may control postural sway, such that increasing sway may be regulated by proximal coordination strategies and vestibular responses, with implications for fall risk.     

What is the price for the Duchenne gait pattern in patients with cerebral palsy?

Duchenne gait is characterized by trunk lean towards the affected stance limb with the pelvis stable or elevated on the swinging limb side during single limb stance phase. We assessed the relationship between hip abduction moments and trunk kinetics in patients with cerebral palsy showing excessive lateral trunk motion. Data of 18 subjects with bilateral spastic cerebral palsy (CP) and 20 aged matched typically developing subjects (TD) were collected retrospectively. Criteria for patient selection were barefoot walking without aid presenting with excessive lateral trunk motion. Subjects had been monitored by conventional 3D gait analysis of the lower extremity including four markers for monitoring trunk motion. Post-hoc, a generic musculoskeletal full body model (OpenSim 3.3) assuming a rigid trunk articulated to the pelvis by a single ball joint was applied for analyzing joint kinematics and kinetics of the lower limb joints including this spine joint. Joint angle ranges of motion, maximum joint moments and powers in the frontal plane as well as mechanical work were calculated and averaged within groups showing prominent differences between groups in all parameters. To the best of our knowledge, this is the first work explicitly looking into the kinetics of Duchenne gait in patients with CP, clinically known as compensation for unloading hip abductor muscles. The results show that excessive lateral trunk motion may indeed be an extremely effective compensation mechanism to unload the hip abductors in single limb stance but for the price of a drastic increase in demand on trunk muscle effort and work.     

The effect of arm movements on the lower limb during gait after a stroke

The purpose of this study was to examine the influence of arm movements on lower limb movement and muscle activation during treadmill walking after a stroke. Ten high functioning stroke and 10 healthy subjects walked on a treadmill while swinging their arms naturally, and while holding onto handles that were either fixed in place or allowed to slide along horizontal handrails. Full-body kinematics were recorded, along with bilateral surface electromyography from lower limb muscles. Arm movements influenced lower limb muscle activity but had little effect on movement patterns at the joints. When handrails were present a small amount of weight was borne through the upper limbs, and for stroke subjects this was reduced when the handles were free to slide. Activity of proximal leg muscles during stance was affected by the weight borne through the upper limbs, increasing when arm movements were performed. Soleus activity during stance was greatest with unsupported arm movements. In stroke subjects, early stance tibialis anterior activity in the paretic leg was greatest with no arm movements, and early swing tibialis anterior activity in both legs was greatest with unsupported arm movements. Many of the changes in muscle activation appeared to be due to changes in postural stability that occurred when performing arm movements. Overall, results support further study of the long-term changes associated with the inclusion of arm movements in gait rehabilitation protocols.     

Postural corrections after standardised perturbations of single limb stance: effect of training and orthotic devices in patients with ankle instability.

OBJECTIVE: Soccer players with functional instability of the ankle joint have shown impairment of postural control in single limb stance. The aim of this study was to examine the effect of stance perturbation. METHODS: A standardised method for the study of postural corrections after perturbation (Equitest) was used. Female soccer players with and without functional instability were examined. RESULTS: The subjects showed a relative change from ankle to hip synergy at medially directed translations of the support surface. This impairment was restored after eight weeks of ankle disk training. The effect of a shoe and brace did not exceed the effect of the shoe alone. CONCLUSIONS: Functional instability seems to be related to impaired ability to retain equilibrium in single limb stance by means of ankle corrections. A positive effect of ankle disk training leading to functional restoration was confirmed.     

Increasing obstacle height and decreasing toe-obstacle distance affect the joint moments of the stance limb differently when stepping over an obstacle

Foot placement during gait is important in regulating the dynamics of the joints of the supporting limb and in maintaining balance of the whole body. We hypothesized that increasing obstacle height and decreasing toe-obstacle distance (distance between the trailing foot and the obstacle during stance of the trailing foot just prior to stepping over the obstacle) would affect the joint moments of the stance limb differently when stepping over an obstacle. A total of 14 healthy young adults stepped over an obstacle 51, 102, 153, and 204 mm in height in a self-selected manner (i.e. toe-obstacle distance was not controlled) and for toe-obstacle distance targets of 10, 20, 30, and 40% of their step lengths measured during unobstructed gait. The adduction and internal rotation moments at the ankle joint increased as toe-obstacle distance decreased. The adduction and internal rotation moments at the hip joint during early stance, the internal rotation moment at the knee joint during late stance, and the dorsiflexion moment at the ankle joint during late stance increased with obstacle height. Reductions in toe-obstacle distance had greater effects on the moments of the ankle joint, and increases in obstacle height had greater effects on the moments of the hip joint. These greater demands on joint moments may affect the abilities of those elderly having decreased muscle strengths to safely step over obstacles.     

Postural adaptation to walking on inclined surfaces: I. Normal strategies.

This study investigated the postural strategies to adapt to uphill and downhill treadmill inclination (0, 5 and 10%) during walking and standing in eight healthy subjects. Increasing the treadmill grade from 0 to 10% induced an increasingly flexed posture of the hip, knee and ankle at initial foot contact as well as a progressive forward tilt of pelvis and trunk. These postural changes were accompanied by a progressive decrease in pelvic lateral drop toward the swinging limb and a gradual increase in stride length as the uphill slope became steeper. Decreasing the treadmill grade from 0 to -10% lead to a decreasingly flexed posture of the hip at initial foot contact as well as an increase in knee flexion during weight acceptance and late stance. These changes were accompanied by a gradual decrease in stride length, a progressive backward tilt of trunk and pelvis and an increase in pelvic lateral drop toward the swinging limb as downhill slope became steeper. Changes in trunk and pelvic postural alignment in the sagittal plane might be used to facilitate power generation or absorption in adapting to slope changes during walking. During quiet standing, however, the trunk and pelvis remained aligned with respect to earth's vertical at any surface inclination. These results showed that postural adaptations are task-specific and the control requirements are different between standing and walking on an inclined surface.     

Differences in lower extremity muscular coactivation during postural control between healthy and obese adults

IntroductionIt is well established that obesity is associated with deterioration in postural control that may reduce obese adults’ autonomy and increase risks of falls. However, neuromuscular mechanisms through which postural control alterations occur in obese adults remain unclear.ObjectiveTo investigate the effects of obesity on muscle coactivation at the ankle joint during static and dynamic postural control.Materials and methodsA control group (CG; n = 20; age = 32.5 ± 7.6 years; BMI = 22.4 ± 2.2 Kg/m²) and an obese group (OG; n = 20; age = 34.2 ± 5.6 years; BMI = 38.6 ± 4.1 Kg/m²) participated in this study. Static postural control was evaluated by center of pressure (CoP) displacements during quiet standing. Dynamic postural control was assessed by the maximal distance traveled by the CoP during a forward lean test. Electromyography activity data for the gastrocnemius medialis (GM), soleus (SOL) and tibialis anterior (TA) were collected during both quiet standing and forward lean tests. Muscle activities were used to calculate two separate coactivation indexes (CI) between ankle plantar and dorsal flexors (GM/TA and SOL/TA, respectively).ResultsCoP displacements were higher in the OG than in the CG for quiet standing (p < 0.05). When leaning forward, the maximal distance of the CoP was higher in the CG than in the OG (p < 0.05). Only the CI value calculated for SOL/TA was higher in the OG than in the CG for both static and dynamic tasks (p < 0.05). The SOL/TA CI value in the OG was positively correlated with CoP displacements during quiet standing (r = 0.79; p < 0.05).ConclusionObesity increases muscle coactivation of the soleus and tibialis anterior muscles at the ankle joint during both static and dynamic postural control. This adaptive neuromuscular response may represent a joint stiffening strategy for enhancing stability. Consequently, increased ankle muscle coactivation could not be considered as a good adaptation in obese adults.     

Postural adaptation to unilateral hip muscle fatigue during human bipedal standing

Although previous studies have investigated the effects of bilateral muscle fatigue on bipedal postural control, whether and how the central nervous system could adapt to unilateral muscle fatigue for controlling bipedal stance remains to be investigated. The purpose of the present experiment was designed to address this issue by assessing the effect of unilateral muscle fatigue induced on the hip's abductors of the dominant leg on bipedal standing. Twenty-four young healthy adults stood barefoot, feet together, with their eyes closed and were asked to sway as little as possible. The experimental group (n = 12) executed this postural task in two conditions, pre- and post-fatigue. In the post-fatigue condition, the measurements were performed immediately after a designated fatiguing exercise for the hip abductors of their dominant leg. For the control group (n = 12), this fatiguing exercise was replaced by a laying rest period corresponding to the fatiguing exercise. The distribution of the body weight and plantar centre of foot pressure (CoP) displacements from the non-fatigued and fatigued leg were recorded along the mediolateral and anteroposterior axes using a plantar pressure data acquisition system. Results of the experimental group showed that unilateral muscle fatigue induced on the hip's abductors of the dominant leg had different effects on the plantar CoP displacements (1) under the non-fatigued and fatigued legs, yielding larger displacements under the non-fatigued leg only, and (2) in the anteroposterior and mediolateral axes, yielding larger displacements along the mediolateral axis only. These observations could not be accounted for by any asymmetrical distribution of the body weight on both legs which were similar for both pre- and post-fatigue conditions. The observed postural responses could be viewed as an adaptive process to cope with an unilateral alteration in the hip neuromuscular function induced by the fatiguing exercise for controlling bipedal stance. The increase in CoP displacements observed under the non-fatigued leg in the fatigue condition could reflect enhanced exploratory “testing of the ground” movements with sensors of the non-fatigued leg's feet, providing supplementary somatosensory inputs to the central nervous system to preserve/facilitate postural control in condition of altered neuromuscular function of the dominant leg's hip abductors induced by the fatiguing exercise.     

Resilience of visually guided weight shifting to a proprioceptive perturbation depends on the complexity of the guidance stimulus

BackgroundWhole-body tracking of visual motion cues is used in balance training to improve weight shifting ability in old age and sports.Research questionHow tracking of a complex (pink noise) and a periodic visual target motion during anteroposterior weight shifting affects postural and muscle responses to unilateral hip vibration.MethodsTwenty-six participants performed 160 anteroposterior weight shifting cycles while tracking the vertical motion of a visual target, concurrently receiving Center of Pressure (CoP) feedback. They were randomly divided to groups; (a) the Constant group tracked a visual target motion constructed by 3 sinusoids of different amplitude, and (b) the Pink group tracked a complex visual target motion constructed by a pink noise generation process. Between the 60th and the 120th cycle, vibration was applied to the right gluteus medius, introducing a sideways CoP deviation. CoP displacement and electromyographic (EMG) responses of soleus, tibialis anterior and peroneus longus were recorded and summarized in blocks of 3 cycles.ResultsSideways CoP deviation induced at the onset/offset of unilateral hip vibration was smaller for the Pink than the Constant group. The Pink group demonstrated greater tibialis anterior and peroneus longus EMG activity around the most anterior sway peak while soleus EMG was similar for the two groups. Both groups successfully coupled weight shifting amplitude to the target motion, but the Pink group tracked the target motion with a greater delay compared to the Constant group.SignificanceWhole body tracking of complex visual motions evokes perception-based action and increases ankle muscle co-activation making sway more resilient to a proprioceptive perturbation induced by unilateral hip vibration. Complex visual guidance motions should be considered when designing balance rehabilitation regimes, aiming at improving weight shifting ability and dynamic balance control.     

Stair ascent kinematics and kinetics with a powered lower leg system following transtibial amputation

During stair ascent (STA) persons with transtibial amputation (TTA) typically adopt a hip strategy to compensate for the limited ankle motion and joint power that is characteristic of conventional energy storing and returning (ESR) prosthetic feet. The purpose of this investigation was to determine if providing ankle power via a powered prosthetic device (BiOM) normalized STA kinematics and kinetics. Eleven individuals with TTA participated in two STA gait analysis sessions: (1) using an ESR foot, and (2) using the BiOM. Eleven height and weight matched able-bodied controls (CONT) were also assessed. Lower extremity peak kinematic and kinetic values were calculated at a self-selected and controlled cadence (80 steps/min). Increased prosthetic limb peak ankle plantarflexion and push-up power were observed while using the BiOM as compared to ESR. Peak ankle power was not significantly different between BiOM and CONT indicating normalization of ankle power generation. However, peak ankle plantarflexion was significantly lower than CONT. Limb asymmetries including greater prosthetic limb hip flexion and power during stance, and decreased prosthetic limb knee power during stance were observed in the BiOM and ESR conditions. The results suggest that the BiOM successfully increased ankle motion and restored ankle power during STA. These differences did not, however, reduce the use of a hip strategy while ascending stairs. Additional device specific training may be necessary to utilize the full benefits of the device.     

Muscle coordination and function during cutting movements

PURPOSE: The objectives of this study were to: 1) establish a database of kinematic and EMG data during cutting movements, 2) describe normal muscle function and coordination of 12 lower extremity muscles during cutting movements susceptible to ankle sprains, and 3) identify potential muscle coordination deficiencies that may lead to ankle sprain injuries. METHODS: Kinematic, EMG, and GRF data were collected from 10 recreationally active male subjects during both a side-shuffle and v-cut movement. RESULTS: The data showed that muscles functioned similarly during both movements. The primary function of the hip and knee extensors was to decelerate the center-of-mass during landing and to provide propulsion during toe-off. The hip add/abductors functioned primarily to stabilize the hip rather than provide mechanical power. The ankle plantar flexors functioned to provide propulsion during toe-off, and the gastrocnemius had an additional burst of activity to plantarflex the foot before touchdown during the side-shuffle to help absorb the impact. The tibialis anterior functioned differently during each movement: to dorsiflex and supinate the foot after toe-off in preparation for the next step cycle during the side-shuffle and to dorsiflex the foot before impact to provide the heel-down landing and ankle stability in the stance phase during the v-cut. CONCLUSIONS: The muscles crossing the ankle joint, especially the tibialis anterior and peroneus longus, may play an important role to prevent ankle sprain injuries. Both muscles provided stability about the subtalar joint by preventing excessive joint rotations. Future theoretical studies with forward dynamic simulations incorporating individual muscle actuators are needed to quantify the segment accelerations induced by active muscles which may prevent or lead to ankle sprain injuries.     

Intrinsic foot muscles act to stabilise the foot when greater fluctuations in centre of pressure movement result from increased postural balance challenge

BackgroundIncreased postural balance challenge is associated with more fluctuations in centre of pressure movement, indicating increased interference from the postural control system. The role of intrinsic foot muscles in balance control is relatively understudied and whether such control system interference occurs at the level of these muscles is unknown.Research QuestionDo fewer fluctuations in intrinsic foot muscle excitation occur in response to increased postural balance challenge?MethodsSurface EMGs were recorded using a grid of 13 × 5 channels from the plantar surface of the foot of 17 participants, who completed three balance tasks: bipedal stance; single leg stance and bipedal tip-toe. Centre of pressure (CoP) movement was calculated from simultaneously recorded force plate signals. Fluctuations in CoP and EMGs for each task were quantified using a sample entropy based metric, Entropy Halflife (EnHL). Longer EnHL indicates fewer signal fluctuations.ResultsThe shortest EMG EnHL, 9.27 ± 3.34 ms (median ± interquartile range), occurred during bipedal stance and the longest during bipedal tip-toe 15.46 ± 11.16 ms, with 18.80 ± 8.00 ms recorded for single leg stance. Differences were statistically significant between bipedal stance and both bipedal tip-toe (p < 0.001) and single leg stance (p < 0.001). CoP EnHL for both anterior-posterior and medial-lateral movements also differed significantly between tasks (p < 0.001, both cases). However, anterior-posterior CoP EnHL was longest for bipedal stance 259.84±230.22 ms and shortest for bipedal tip-toe 146.25±73.35 ms. Medial-lateral CoP EnHL was also longest during bipedal stance 215.73±187.58 ms, but shortest for single leg stance 113.48±83.01 ms.SignificanceFewer fluctuations in intrinsic foot muscle excitation occur in response to increased postural balance challenge. Fluctuations in CoP movement during balance must be predominantly driven by excitation of muscles extrinsic to the foot. Intrinsic foot muscles therefore likely play a greater role in stabilisation of the foot than balance control during the postural tasks studied.     

Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis

The greatest population of amputees in developed nations are elderly dysvascular transtibial amputees. Conventional prostheses, e.g. the solid ankle cushioned heel (SACH) foot, create difficulties in walking on inclines. The aim of this study was to analyse the gait characteristics of elderly amputees walking on an incline, through quantitative three-dimensional biomechanical analysis, by comparing them to age-matched controls. Participants walked up and down an inclined (5 degrees) instrumented walkway at a self-selected pace. A Vicon System 370 was used to acquire gait data, including temporo-spatial characteristics, ground reaction forces (GRF), electromyography (EMG), kinematics, and kinetics of the lower limb. Compared to the age-matched controls, the amputees demonstrated reduced speed, knee and hip range of motion, hip moments, vertical GRF, along with increased amplitude and periods of muscle activation. The residual limb also had shorter single support stance phase, small stance phase knee moments, and the smallest moments and powers. These differences demonstrate instability in stance of the residual limb. The sources of this instability include the prosthesis' limited range of ankle motion and ankle power generation, coupled with the residual limb's limited proprioception and tolerance of force. For these amputees to regain a gait pattern equivalent to their able-bodied counterparts on inclined walkways, they must be equipped with a prosthesis that has a full range of ankle motion and active power generation at the ankle. Prosthesis design and rehabilitation training should also improve the proprioception of their residual limb and increase their tolerance of force through the residual limb.     

Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance

BACKGROUND: Impaired muscle activation may predispose subjects to develop chronic ankle instability. It has been suggested that impairments are found not only in structures around the injured ankle but also around the more proximal joint complexes. HYPOTHESIS: Subjects with chronic ankle instability were expected to show later onset times for lower limb and trunk muscle activation when compared with control subjects. They were expected to show less variability in muscle activation patterns compared with the control group. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty control subjects and 10 subjects with chronic ankle instability participated in the study. The onset of muscle activity of 14 muscles of the lower limb and trunk was measured during the transition from a double-leg stance position to a single-leg stance position in eyes-open and eyes-closed test conditions. RESULTS: Subjects with chronic ankle instability showed significantly later onset times for the ankle, hip, and hamstring muscles compared with control subjects. They used a similar muscle activation pattern in both test conditions, whereas control subjects adjusted their activation pattern according to the condition. CONCLUSIONS: Differences in muscle activation patterns between subjects with chronic ankle instability and control subjects occur not only around the ankle but also around other joints. Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions. CLINICAL RELEVANCE: Knowledge of muscle activation patterns in the whole lower limb and trunk in noninjured subjects and the differences found in chronic ankle instability subjects broadens the physical therapy approach to the treatment of chronic ankle instability.     

Lower limb joint motion during a cross cutting movement differs in individuals with and without chronic ankle instability

ObjectiveTo compare the kinematics of lower limb joints between individuals with and without chronic ankle instability (CAI) during cross-turn and -cutting movements.DesignCross-sectional study.SettingMotion analysis laboratory.ParticipantsTwelve subjects with CAI and twelve healthy controls.Main outcome measuresHip flexion, adduction, and internal rotation, knee flexion, and ankle dorsiflexion and inversion angles were calculated in the 200 ms before initial ground contact and from initial ground contact to toe-off (stance phase) in a cross-turn movement during gait and a cross-cutting movement from a forward jump, and compared across the two groups.ResultsIn the cross-cutting movement, the CAI group exhibited greater hip and knee flexion than the control group during the stance phase, and more hip abduction during the period before initial contact and the stance phase. In the cross-turn movement the joint kinematics were similar in the two groups.ConclusionsCAI subjects exhibited an altered pattern of the proximal joint kinematics during a cross-cutting movement. It is important for clinicians to assess the function of the hip and knee as well as the ankle, and to incorporate coordination training for the entire lower limb into rehabilitation after lateral ankle sprains.     

Differences in postural control between healthy and subjects with chronic ankle instability

IntroductionChronic ankle instability (CAI) is characterized by the occurrence of repetitive inversion mechanism of the ankle, resulting in numerous ankle sprains. CAI occurs in approximately 70% of patients with a history of a lateral ankle sprain. Many causes of functional ankle instability have been postulated and include deficits in proprioception, impaired neuromuscular-firing patterns, disturbed balance and postural control.ObjectiveThe purpose of this study was to compare postural control behaviour in subjects with chronic ankle instability and healthy subjects, using the traditional linear and nonlinear variables for the centre of pressure (CoP) displacement, during one-leg stance on stable and unstable surfaces.Methods16 CAI subjects and 20 healthy subjects were evaluated with the single leg stance on a stable surface and an unstable surface, for 60 s with a force plate. The traditional linear variables like CoP displacement, CoP amplitude and CoP velocity were calculated. Variability of CoP displacement was also submitted to nonlinear analysis and the approximated entropy, sample entropy, correlation dimension and Lyapunov exponent were calculated.ResultsOn the stable surface, no differences between groups for all the traditional variables were found but the correlation dimension of CoP mediolateral displacement had lower values on the CAI group with statistical significance (p < 0.05). On the unstable surface, no differences were found neither with linear variable neither with variability nonlinear analysis.ConclusionCorrelated dimension of CoP displacement during one-leg stance on a stable surface was the only variable that show significant differences between the two groups. The lower values of this variable in the CAI subjects may implicate a balance control system with more difficulties to adapt to the environment and the task demands. More studies are needed to better understand CAI subjects balance control.     

The contribution of passive-elastic mechanisms to lower extremity joint kinetics during human walking

The purpose of this study was to investigate the contribution of passive mechanisms to lower extremity joint kinetics in normal walking at slow, comfortable, and fast speeds. Twenty healthy young adults participated in a passive testing protocol in which the relaxed lower limb was manipulated through full sagittal hip, knee, and ankle ranges of motion while kinematics and applied forces were simultaneously measured. The relationship between passive joint moments and angles was modeled by a set of exponential functions that accounted for the stretch of uniarticular structures and biarticular muscles. Subject specific walking kinematics (80%, 100%, and 120% of preferred speed) were input into the passive models to estimate joint moments, power, and work attributable to passive mechanisms. Passive hip flexion moments were substantial from late stance through early swing, absorbing approximately 40% of the net negative work done during hip extension and producing over half of the net positive work done during the hip flexor power burst (H3). Passive ankle plantarflexor moments were also produced during pre-swing, but generated a smaller percentage (10%) of the net ankle plantarflexor power burst (A2). The joint work attributed to passive structures increased significantly (p < 0.05) with walking speed. The biarticular rectus femoris and gastrocnemius allowed for net passive energy absorption at the knee and subsequent return at the hip and ankle (p < 0.05). Together, these results suggest that passive-elastic mechanisms can contribute substantially to normal human walking and that biarticular muscles play a role in passively transferring energy between joints.     

Stabilometry is a predictor of gait performance in chronic hemiparetic stroke patients

In patients with spastic hemiparesis, centre of foot pressure (CoP) is shifted toward the unaffected limb during quiet stance. We hypothesised that abnormal gait features would correlate with the degree of asymmetry during stance. In 15 patients and 17 normals we recorded CoP and body sway by a force platform and measured spatial–temporal variables of gait with pedobarography. In patients CoP was shifted toward the unaffected limb and sway was larger than in normals. CoP position was associated with the decrease in strength of the affected lower-limb muscles. Spatio-temporal variables of gait were also affected by the disease. Cadence and velocity were decreased, duration of single support on the unaffected limb and of double support were increased with respect to normals. The degree of impairment of gait variables correlated with CoP. We found a negative relationship between velocity or cadence and CoP, and a positive relationship between duration of single support and CoP in the unaffected but not in the affected limb. Duration of double support correlated positively with CoP. CoP asymmetry during both standing and walking suggests that postural and gait problems share some common neural origin in hemiparetic patients. This asymmetry affects gait performance by increasing the time and effort needed to shift body weight toward the affected limb. The degree of postural asymmetry measured by stabilometry is associated with the level of impairment of gait variables.     

Accuracy of passive ankle joint positioning during quiet stance in young and elderly subjects

Age-related postural deficits elicit compensatory mechanisms such as ankle dorsiflexion in the elderly. To gain further insight into this problem, the ability to match an ankle angle during quiet stance was studied in 12 elderly and 12 young subjects. Following an initial single limb angular perturbation presented in the ±4° range, a subject had to return a tilt platform to level, as determined by the nonperturbed limb. Elderly subjects exhibited significant positive (0.9°) over-shoot of the level position, in contrast to young subjects who matched ankle angle with a mean error of −0.1°. The elderly group also exhibited an increase in positioning error for angular displacements in the range between −1 and +1°. The results document age-related postural changes in ankle positioning which might affect postural stability in older adults.     

Modification of human postural responses to soleus muscle vibration by rotation of visual scene

Sensory interaction in posture control in 20 healthy subjects was investigated by postural responses to differently timed proprioceptive and visual stimulation. As proprioceptive stimulation was used both soleus muscles vibration. Visual stimulation was rotating disc moving in forward and backward direction. Centre of foot pressure (CoP) and trunk tilts in antero-posterior (AP) direction were measured during stance by two accelerometers on the upper and the lower trunk level. Subjects performed four series of eight trials lasted 20s: vibration with eyes open and closed, visual scene motion forward or backward, vibration together with scene motion forward or backward, scene motion forward or backward 3s before vibration. The results showed that early velocities and final angles of body tilt induced by soleus muscle vibration were modified by motion of visual scene. Early part of postural responses was changed slightly if sensory stimulation starts together. When visual stimulation started 3s before muscle vibration, the induced early CoP and trunk tilt records of postural response to vibration occurred with the faster slope similar for both directions of scene motion and for condition of vibration alone with eyes closed. Significantly different final CoP shifts and trunk angles were measured between condition with visual scene motion forward and backward. The effect of visual input on posture control was two times enhanced in paired sensory stimulation. The results indicated an important influence of unstable visual field on posture response to somatosensory stimulation where the early part of postural reaction indicated absence of visual influence.