Postural effects of imagined leg pain as a function of hypnotizability

It has been shown that, in subjects with high hypnotizability (Highs), imagined somatosensory stimulation can involuntarily activate the neural circuits involved in the modulation of reflex action. In this vein, aim of the study was to investigate whether the imagery of nociceptive stimulation in one leg may produce both subjective experience of pain and congruent postural adjustments during normal upright stance. The displacement of the centre of pressure (CoP) was studied during imagery of leg pain (LP) and during the control conditions of imagery of tactile stimulation of the same leg and of throat pain (TP) in 12 Highs and 12 low hypnotizable subjects (Lows). The results showed that the vividness of imagery was higher in Highs than in Lows for all tasks and that only Highs reported actually feeling pain during LP and TP. Congruently, during LP only Highs displaced their CoP towards the leg opposite to the one that was the object of painful imagery and increased their CoP mean velocity and area of excursion. Since the Highs’ postural changes were not accounted for only by vividness of imagery and perceived pain intensity, high hypnotizability is apparently responsible for part of the postural effects of pain imagery.     

Can imagery become reality?

Previous studies showed that highly hypnotizable persons imagining a specific sensory context behave according to the corresponding real stimulation and perceive their behaviour as involuntary. The aim of the study was to confirm the hypothesis of a translation of sensory imagery into real perception and, thus, of a true involuntary response. We studied the imagery-induced modulation of the vestibulospinal (VS) reflex earlier component in highly (Highs) and low hypnotizable subjects (Lows), as it is not affected by voluntary control, its amplitude depends on the stimulus intensity, and the plane of body sway depends on the position of the head with respect to the trunk. Results showed that the effects of the “obstructive” imagery of anaesthesia are different from those elicited by the “constructive” imagery of head rotation. Indeed, both Highs and Lows having their face forward and reporting high vividness of imagery experienced anaesthesia and reduced their VS reflex amplitude in the frontal plane, while only Highs changed the plane of body sway according to the imagined head rotation that is from the frontal to the sagittal one. These effects cannot be voluntary and should be attributed to translation of sensory imagery into the corresponding real perception.     

Hypnotizability-related EEG alpha and theta activities during visual and somesthetic imageries

Hypnotizability is a cognitive multidimensional trait that involves peculiar imagery characteristics. Subjects with high- (Highs) and low (Lows)-susceptibilities to hypnosis have shown different levels of skill at visual and somesthetic-guided imageries performed during upright stance. The aim of this experiment is to study the modulation of the EEG alpha and theta band amplitude during guided visual and somesthetic imageries in Highs and Lows, as these rhythms are responsive to the cognitive activities involved in mental imagery. Our results show that, at variance with standing subjects, subjects in both groups in a semi-reclined position report higher vividness and lower effort for visual than for somesthetic imagery. EEG patterns however are different between the two groups. Highs exhibit a more widespread alpha desynchronization and slightly different EEG patterns during visual and somesthetic imageries, while Lows show segregated alpha- and theta-desynchronization, without any difference between the tasks. Our results indicate that different, hypnotizability-related cognitive strategies, that are revealed by differences in EEG modulation, are responsible for the similar subjective experience associated with visual and somesthetic imageries in Highs and Lows. In addition, in both groups higher order mental representation of different sensory modalities might be subserved by a unique integrated neural network.     

Hypnotizability and haptics: visual recognition of unimanually explored ‘nonmeaningful’ objects

The cognitive trait of hypnotizability modulates sensorimotor integration and mental imagery. In particular, earlier results show that visual recognition of ‘nonmeaningful’, unfamiliar objects bimanually explored is faster and more accurate in subjects with high (Highs) than with low hypnotizability (Lows). The present study was aimed at investigating whether Highs exhibit a similar advantage after unimanual exploration. Recognition frequency (RF) and Recognition time (RT) of correct recognitions of the explored objects were recorded. The results showed the absence of any hypnotizability-related difference in recognition frequencies. In addition, RF of the right and left hand was comparable in Highs as in Lows, while slight differences were found in RT. We suggest that hemispheric co-operation played a key role in the better performance of Highs in the bimanual task previously studied. In the unimanual exploration, the task’s characteristics (favoring the left hand), hypnotizability-related cerebral asymmetry (favoring the right hand in Highs) and the possible preferential verbal style of recognition in Lows (favoring the right hand in this group) antagonize each other and prevent the occurrence of major differences between the performance of Highs and Lows.     

Is high hypnotizability a trouble in balance control?

Hypnotizability is a cognitive trait measured by standard scales and associated with peculiar physiological responses to cognitive and physical stimulations. Hypnotizability-related differences can also be observed in non-hypnotic state and in the absence of specific suggestions. In the normal bipedal stance subjects with high hypnotizability (Highs) exhibit a higher tolerance of alteration of the visual and leg/neck proprioceptive input with respect to low hypnotizable individuals (Lows). Aim of the study was to investigate whether this characteristic represents a disadvantage during highly demanding postural tasks. Sixteen Highs and 16 Lows of both genders participated in an experimental session consisting of maintaining balance while standing with open or closed eyes on a seesaw platform allowing roll movements. The results did not show significant differences between Highs and Lows in inclination area and time, with the exception of a greater ability of Highs with respect to Lows when they began the task displacing the body weight from the left to the right leg. Thus, high hypnotizability does not represent a disadvantage for balance control during highly demanding postural tasks. Together with previous studies, the present findings suggest that the Highs’ postural control might shift from a very “economic”, preeminently centrally driven functioning mode, characteristic of easy postural tasks, to an efficaciously periphery-controlled mode, required by difficult postural tasks.     

Hypnotizability-dependent accuracy in the reproduction of haptically explored paths

The study assessed differences between highly (Highs) and low hypnotizable (Lows) subjects in the blindfolded reproduction of paths connected at acute or obtuse angles. Reproduction attempts were made after path exploration performed by one finger, with or without concomitant cognitive activities (mental computation or imagery of exploring an angle larger than the explored one). The variables analyzed were: subjective experience (scores of the exploring effort, reproduction difficulty, perceived accuracy of reproduction, attention to mental computation and efficacy of imagery), exploration time, relative error in reproduction (under or overestimation) and the percentage of “successful” trials (absolute error <10°). The results showed that the subjective experience of exploration/reproduction and the exploration times are similar in Highs and Lows and that all subjects underestimate the explored angles and reproduce the acute angle more accurately than the obtuse one. Exploration of the acute angle concomitant with imagery of a larger one reduced its underestimation in both groups. Highs exhibited a larger number of successful trials after exploration of the obtuse angle, while Lows (males) decreased their relative error in the reproduction of the acute angle. In conclusion, in the more demanding condition of reproducing an obtuse angle, the Highs’ reproduction was more accurate and more independent of cognitive load than that of the Lows.     

Modulation of the postural effects of cognitive load by hypnotizability

Aim of the experiment was to study whether cognitive load affects postural control more in low (Lows) than in highly hypnotizable (Highs) subjects due to the latter’s greater attentional abilities. Standing Highs and Lows underwent an experimental session (closed eyes) consisting of a basal condition and of mental computation in an easy (stable support) and a difficult (unstable support) postural condition. Variability [standard deviation (SD)] and complexity [sample entropy (SampEn)] of the movement of the centre of pressure (CoP), its mean velocity (Velocity), the area swept by the CoP (Area) and the ratio between the CoP trajectory length and area [length for surface (LFS)] were measured. Few hypnotizability-related differences were detected (reduction in the Highs’ SD and increases in the Lows’ LFS in the difficult postural condition). Thus, the hypnotizability-related postural differences observed in previous studies during sensory alteration could not be accounted mainly by attentional abilities. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. An erratum to this article can be found at     

Age-related differences in postural control: effects of the complexity of visual manipulation and sensorimotor contribution to postural performance

Patterns of adaptive changes to the exposure to a sinusoidal visual stimulus can be influenced by stimulus characteristics as well as the integrity of the sensory and motor systems involved in the task. Sensorimotor deficits due to aging might alter postural responses to visual manipulation, especially in more demanding tasks. The purpose of this study was to compare postural control between young and older adults at different levels of complexity and to examine whether possible sensory and/or motor changes account for postural performance differences in older adults. Older and young adults were submitted to the following tests: postural control assessments, i.e., body sway during upright stance and induced by movement of a visual scene (moving room paradigm); sensory assessments, i.e., visual (acuity and contrast sensitivity) and somatosensory (tactile foot sensitivity and detection of passive ankle motion); and motor assessments, i.e., isometric ankle torque and muscular activity latency after stance perturbation. Older adults had worse sensory and motor performance, larger body sway amplitude during stance and stronger coupling between body sway and moving room motion than younger adults. Multiple linear regression analyses indicated that the threshold for the detection of passive ankle motion contributed the most to variances in body sway and this contribution was more striking when visual information was manipulated in a more unpredictable way. The present study suggests that less accurate information about body position is more detrimental to controlling body position, mainly for older adults in more demanding tasks.     

Tactile directional sensitivity and postural control

People are good at telling the direction of a moving tactile stimulus and this capacity provides a sensitive clinical test of somatosensory disturbances. Tactile directional sensitivity depends on two different kinds of somatosensory information, i.e. spatiotemporal information and information about friction-induced changes in skin stretch. The objective of this study was to compare the relative contribution to postural control of these two types of information for both glabrous and hairy skin. Postural sway amplitudes and sway paths were recorded, with or without access to tactile and/or visual stabilizing stimuli. Subjects were standing on two types of surface, either solid metal or 50 mm foam plastic. Two types of stimulus were used to generate sway-related tactile information. One was a thin air-stream that was used to assess the contribution by spatiotemporal information, and the second was a narrow steel rod that was glued to the skin to assess the contribution by skin-stretch information. The stimuli were applied to the hairy skin of the forearm and to the glabrous skin of the fingertip. In addition, we studied the ability to tell the direction of movement of an air-stream stimulus on glabrous and hairy skin. The air-stream caused significant sway reductions when applied to glabrous, but not hairy skin. The weak effect on hairy skin reflected the perceptually poor directional sensitivity for the air-stream stimulus in this cutaneous area. In contrast, the glued rod reduced sway when applied to both glabrous and hairy skin reflecting the tactile afferents high sensitivity to skin stretch in these areas. Both types of tactile stimulus reduced sway amplitudes more than sway paths for both hairy and glabrous skin. The visual cue, on the other hand, tended to reduce sway paths more than amplitudes. The two types of tactile receptive surface seem to influence postural control in the same manner, despite anatomical and physiological differences. The results invite speculation that patients with poor directional sensitivity might have reduced postural stability compared with healthy individuals.     

Kinesthetic motor imagery modulates body sway

The aim of this study was to investigate the effect of imagining an action implicating the body axis in the kinesthetic and visual motor imagery modalities upon the balance control system. Body sway analysis (measurement of center of pressure, CoP) together with electromyography (EMG) recording and verbal evaluation of imagery abilities were obtained from subjects during four tasks, performed in the upright position: to execute bilateral plantar flexions; to imagine themselves executing bilateral plantar flexions (kinesthetic modality); to imagine someone else executing the same movement (visual modality), and to imagine themselves singing a song (as a control imagery task). Body sway analysis revealed that kinesthetic imagery leads to a general increase in CoP oscillation, as reflected by an enhanced area of displacement. This effect was also verified for the CoP standard deviation in the medial–lateral direction. An increase in the trembling displacement (equivalent to center of pressure minus center of gravity) restricted to the anterior–posterior direction was also observed to occur during kinesthetic imagery. The visual imagery task did not differ from the control (sing) task for any of the analyzed parameters. No difference in the subjects' ability to perform the imagery tasks was found. No modulation of EMG data were observed across imagery tasks, indicating that there was no actual execution during motor imagination. These results suggest that motor imagery performed in the kinesthetic modality evokes motor representations involved in balance control.     

Low-frequency common modulation of soleus motor unit discharge is enhanced during postural control in humans

The maintenance of quiet stance requires the activation of muscles bilaterally. The soleus muscles in each leg share a common function in standing; that is, each muscle acts to control antero-posterior (AP) sway on its own side. We sought to determine the extent to which oscillations in motor unit discharge were related in motor unit pairs of the soleus muscles during postural and voluntary isometric tasks, both within and between legs. Subjects stood quietly for 5 min or performed a voluntary isometric plantarflexion contraction in a seated position. During the postural tasks, the excursions of AP sway between legs were highly correlated (ρ = 0.86 ± 0.06). The strength of common modulation of motor unit discharge rates was assessed using time- and frequency-domain analyses. The time-domain common drive analysis revealed that the strongest correlation in motor unit discharge modulation occurred in the postural task with unilateral pairs (ρ = 0.71 ± 0.13) being more strongly correlated than bilateral pairs (ρ = 0.50 ± 0.16). Common modulation of motor unit discharge was lowest for the voluntary tasks, with ρ = 0.38 ± 0.11 and 0.16 ± 0.08 for unilateral and bilateral pairs, respectively. Similarly, the frequency-domain coherence analysis demonstrated an identical ordering effect, with the largest maximum pooled coherence occurring during standing posture in unilateral (0.070 at 1.6 Hz) and bilateral (0.055 at 1.6 Hz) recordings, whereas minimal coherence was observed in the voluntary task in both unilateral and bilateral recordings within the 0–5 Hz range. These results indicate that in the soleus muscle, common modulation of motor unit discharge is greater during postural tasks than during voluntary isometric tasks and can be observed in both bilateral and unilateral motor unit pairs. Differences in the extent of co-modulation of motor unit discharge between tasks may be attributed to either differences in the descending control or differences in the proprioceptive input between postural and isometric tasks.This study was supported by an NSERC grant awarded to S.J. Garland and a CIHR doctoral fellowship awarded to G. Mochizuki.     

Task-specific adaptations of postural sway in sitting infants

When engaging in manual or visual tasks while sitting, infants modify their postural sway based on concurrent task demands. It remains unclear whether these modulations are sensitive to differences in concurrent task demands (holding a toy vs. looking at a toy being held by someone else), and whether the properties of the support surface impact these adaptations. We investigated infants’ ability to modify postural sway when holding a toy or visually attending to a toy someone else was holding while sitting on different support surfaces. Twenty-six independently sitting infants sat on solid and compliant surfaces placed on a force plate while looking at or holding a toy. Measures of postural sway were calculated from the center of pressure data. Visually attending to a toy was associated with less sway and lower sway velocity than when holding a toy. Surprisingly, surface compliance did not affect sway and there were no interaction effects. Whereas sway modulations may facilitate infants’ performance on both manual and visual concurrent tasks, the visual task placed more constraints on the postural system leading to greater adaptations in postural sway. These findings provide insights into how infants are allocating attention and coordinating perceptual-motor information in developing sitting skills.     

The influence of dynamic visual cues for postural control in children aged 7–12 years

Young children rely heavily on vision for postural control during the transition to walking. Although by 10 years of age, children have automatic postural responses similar to adults, it is not clear when the integration of sensory inputs becomes fully developed. The purpose of this study was to examine this transition in the sensory integration process in children aged 7–12 years. Healthy children and adults stood on a fixed or sway-referenced support surface while viewing full-field optic flow scenes that moved sinusoidally (0.1 and 0.25 Hz) in an anterior–posterior direction. Center of pressure was recorded, and measures of sway amplitude and phase were calculated at each stimulus frequency. Children and adults had significant postural responses during approximately two-thirds of the trials. In adults, there was a 90% decrease in sway on the fixed surface compared with the sway-referenced surface, but only a 50% decrease in children. The phase between the optic flow stimulus and postural response in children led that of adults by 52° at 0.1 Hz and by 15° at 0.25 Hz. Adults and children aged 7–12 years have similar ability to use dynamic visual cues for postural control. However, 7–12-year-old children do not utilize somatosensory cues to stabilize posture to the same extent as adults when visual and somatosensory cues are conflicting.     

Postural sway and perception of affordances in children at risk for developmental coordination disorder

Gibson (The ecological approach to visual perception, Houghton Mifflin, Boston, 1979/1986) defined affordances as opportunities for motor behaviors, and highly emphasized the interaction between perception and action. Research on children with developmental coordination disorder commonly reports difficulties in judgments of affordances (perception) and in postural control (action). However, how perception and action are coupled has not been studied yet. The present study sought to evaluate the relationship between control of postural sway and perception of affordances in children at risk for developmental coordination disorder (RDCD) and typically developing children (TDC). We hypothesized that the relationship between perception and action would differ between groups. Participants made a series of judgments about their maximum sitting height (SHmax) while standing with and without wearing 10 cm blocks on feet. Postural sway and the judgment accuracy were recorded. Our findings showed that RDCD swayed more during judgment sessions and made less accurate judgments compared to TDC. In addition, TDC reduced postural sway from inter-judgment to judgment sessions, whereas the postural sway of RDCD remained identical between sessions. Last, while TDC reduced postural sway across judgment trials and revealed a learning effect of the judgments about SHmax in the block condition, RDCD never modulated postural sway and did not learn their SHmax in both non-block and block conditions. Overall, modulation of postural sway differed between groups during judgment sessions and between inter-judgment and judgment sessions, whereby their perceptual judgments about SHmax were differentially influenced. To summarize, this study demonstrated a difference in perception and action coupling between RDCD and TDC.     

Assessment of postural instability in patients with Parkinson’s disease

Postural instability is one of the most disabling features of idiopathic Parkinson’s disease (PD). In this study, we focused on postural instability as the main factor predisposing parkinsonians to falls. For this purpose, changes in sway characteristics during quiet stance due to visual feedback exclusion were studied. We searched for postural sway measures that could be potential discriminators for an increased fall risk. A group of 110 subjects: 55 parkinsonians (Hoehn and Yahr: 1–3), and 55 age-matched healthy volunteers participated in the experiment. Their spontaneous sway characteristics while standing quiet with eyes open and eyes closed were analyzed. We found that an increased mediolateral sway and sway area while standing with eyes closed are characteristic of parkinsonian postural instability and may serve to quantify well a tendency to fall. These sway indices significantly correlated with disease severity rated both by the Hoehn and Yahr scale as well as by the Motor Section of the UPDRS. A forward shift of a mean COP position in parkinsonians which reflects their flexed posture was also significantly greater to compare with the elderly subjects and exhibited a high sensitivity to visual conditions. Both groups of postural sway abnormalities identified here may be used as accessible and reliable measures which allow for quantitative assessment of postural instability in Parkinson’s disease.     

Automatic control of postural sway by visual motion parallax

The purpose of this study was to establish whether visual motion parallax participates in the control of postural sway. Body sway was measured in ten normal subjects by photoelectric recordings of head movements and by force-plate posturography. Subjects viewed a visual display (“background”), which briefly moved (2 s) along the y (horizontal) axis, under three different conditions: (1) direct fixation of the background, (2) fixation of a stationary window frame in the foreground, and (3) fixation of the background in the presence of the window in the foreground (“through the window”). In response to background fixation, subjects swayed in the same direction as stimulus motion, but during foreground (window) fixation they swayed in the opposite direction. The earlier forces observed on the force platform occurred at circa 250 ms in both conditions. The results show that motion parallax generates postural responses. The direction of these parallax-evoked postural responses — opposite to other visually evoked postural responses reported so far — is appropriate for stabilizating posture in natural circumstances. The findings show that motion parallax is an important source of self-motion information and that this information participates in the process of automatic postural control. In the “fixating through the window” condition, which does not mimic visual conditions induced by body sway, no consistent postural responses were elicited. This implies that postural reactions elicited by visual motion are not rigid responses to optokinetic stimulation but responses to visual stimuli signalling self-motion.     

Modulation of cortical activity as a result of voluntary postural sway direction: An EEG study

There is increasing evidence demonstrating the role of the cerebral cortex in human postural control. Modulation of EEG both in voltage and frequency domains has been observed preceding and following self-paced postural movements and those induced by external perturbations. The current study set out to provide additional evidence regarding the role of cerebral cortex in human postural control by specifically examining modulation of EEG as a function of postural sway direction. Twelve neurologically normal subjects were instructed to produce self-paced voluntary postural sways in the anterior–posterior (AP) and medial–lateral (ML) directions. The center of pressure dynamics and EEG both in voltage and frequency domains were extracted by averaging and Morlet wavelet techniques, respectively. The amplitude of movement-related cortical potentials (MRCP) was significantly higher preceding ML sways. Also, time–frequency wavelet coefficients (TF) indicated differential modulation of EEG within alpha, beta and gamma bands as a function of voluntary postural sway direction. Thus, ML sway appear to be more difficult and energy demanding tasks than the AP sway as reflected in differential modulation of EEG. These results are discussed within the conceptual framework of differential patterns of brain activation as a result of postural task complexity.     

Watching neutral and threatening movies: subjective experience and autonomic responses in subjects with different hypnotizability levels

Subjects with high hypnotizability scores (Highs) have been considered more prone to experience negative affect and more vulnerable to its autonomic effects with respect to low hypnotizable individuals (Lows). The aim of the study was to analyze the subjective experience, tonic skin conductance (SC), respiratory frequency (RF), heart rate (HR) and heart rate variability (HRV) of healthy Highs and Lows during a long-lasting, emotionally neutral task (Session R, 46 subjects) and a moderately threatening one (Session T, 35 subjects). At the end of the relaxing Session R, all participants reported an increased relaxation. At the end of the threatening Session T, only 20 subjects reported a decreased relaxation (effective T: eT subsample). Highs and Lows of this subsample reported a similarly reduced relaxation and showed a similarly increased skin conductance. HR and HRV did not differ between the two sessions and between Highs and Lows. Among the subjects not reporting decreased relaxation at the end of Session T (ineffective T: iT subsample, n=15), relaxation was deeper and associated with lower skin conductance in Highs, although HR and HRV did not differ between Highs and Lows. All together, the results do not support the hypothesis of higher proneness of Highs to experience negative affect and to exhibit the autonomic correlates of negative emotion.