Human balance and posture control during standing and walking

The common denominator in the assessment of human balance and posture is the inverted pendulum model. If we focus on appropriate versions of the model we can use it to identify the gravitational and acceleration perturbations and pinpoint the motor mechanisms that can defend against any perturbation.

We saw that in quiet standing an ankle strategy applies only in the A/P direction and that a separate hip load/unload strategy by the hip abd/adductors is the totally dominant defence in the M/L direction when standing with feet side by side. In other standing positions (tandem, or intermediate) the two mechanisms still work separately, but their roles reverse. In the tandem position M/L balance is an ankle mechanism (invertors/evertors) while in the A/P direction a hip load/unloading mechanism dominates.

During initiation and termination of gait these two separate mechanisms control the trajectory of the COP to ensure the desired acceleration and deceleration of the COM. During initiation the initial acceleration of the COM forward towards the stance limb is achieved by a posterior and lateral movement of the COP towards the swing limb. After this release phase there is a sudden loading of the stance limb which shifts the COP to the stance limb. The COM is now accelerated forward and laterally towards the future position of the swinging foot. Also M/L shifts of the COP were controlled by the hip abductors/adductors and all A/P shifts were under the control of the ankle plantar/dorsiflexors. During termination the trajectory of both COM and COP reverse. As the final weight-bearing on the stance foot takes place the COM is passing forward along the medial border of that foot. Hyperactivity of that foot's plantarflexors takes the COP forward and when the final foot begins to bear weight the COP moves rapidly across and suddenly stops at a position ahead of the future position of the COM. Then the plantarflexors of both feet release and allow the COP to move posteriorly and approach the COM and meet it as quiet stance is achieved. The inverted pendulum model permitted us to understand the separate roles of the two mechanisms during these critical unbalancing and rebalancing periods.

During walking the inverted pendulum model explained the dynamics of the balance of HAT in both the A/P and M/L directions. Here the model includes the couple due to the acceleration of the weight-bearing hip as well as gravitational perturbations. The exclusive control of A/P balance and posture are the hip extensors and flexors, while in the M/L direction the dominant control is with the hip abductors with very minor adductor involvement. At the ankle the inverted pendulum model sees the COM passing forward along the medial border to the weight-bearing foot. The model predicts that during single support the body is falling forward and being accelerated medially towards the future position of the swing foot. The model predicts an insignificant role of the ankle invertors/evertors in the M/L control. Rather, the future position of the swing foot is the critical variable or more specifically the lateral displacement from the COM at the start of single support. The position is actually under the control of the hip abd/adductors during the previous early swing phase.

The critical importance of the hip abductors/adductors in balance during all phases of standing and walking is now evident. This separate mechanism is important from a neural control perspective and clinically it focuses major attention on therapy and potential problems with some surgical procedures. On the other hand the minuscule role of the ankle invertors/evertors is important to note. Except for the tandem standing position these muscles have negligible involvement in balance control.     

Shared care: a review of the literature

This review examines broad issues of concern regarding the primary/secondarycare interface. The main purpose was to identify areas of goodpractice which could be adapted for more general use. One ofthe most fundamental aspects identified was communication, whichis discussed in some detail. Also covered are shared prescribingand disease management. The data suggest that the most effectivesystem(s) of shared care has yet to be established. Furtherqualitative and economic evaluations are required, taking intoaccount patient preferences. Although the literature does describecertain practice exemplars, it is clear that inter- and intra-professionalcommunication continues to be a problem. Whilst informationtechnology may provide some of the solutions, it is concludedthat a culture change, which compels health professionals tomake sharing of patient information a much higher priority,is reauired. Keywords. Shared care, seamless care, hospital, general practice, family practice.     

Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans

In 260 asbestos-exposed individuals evaluated by means of computed tomography (CT), 43 unsuspected pulmonary masses were found in 27 individuals. The masses included fissural pleural plaques (n = 10), dense fibrotic bands (n = 3), round atelectasis (n = 11), carcinomas (n = 3), and other presumed benign masses (n = 16). The most helpful features in the diagnosis of rounded atelectasis with CT were (a) contiguity to areas of diffuse pleural thickening, (b) a lentiform or wedge-shaped outline, (c) evidence of volume loss in the adjacent lung, and (d) a characteristic "comet tail" of vessels and bronchi sweeping into the margins of the mass. Less advanced areas of focal atelectasis had fewer classic features. Intrafissural pleural plaques were readily identified with high-resolution CT. In asbestos-related masses, the demonstration of stability over time is necessary. Careful interpretation of CT and high-resolution CT features and close surveillance can obviate the need for biopsy in the majority of instances.     

Immunological relationship among human adenoviruses of subgenus D

Summary Antigenic relationships between adenoviruses of subgenus D were determined by neutralization tests in HeLa cell cultures by CPE inhibition. For cross-testing, several antisera of the same species were tested against the prototype viruses 39 wild strains belonging to 12 different virus species were also studied. Marked variation in the degree of cross-neutralization between individual sera of the same species was often observed. However, virus strains within a species mostly showed identical serological reactions. Hence, antigenic specificity appears to be a fairly constant property of any one species.Strong cross-neutralizations between species are presumably due to a relationship of the (hexon) antigen, whereas weak cross-neutralizations found between viruses related by hemagglutination-inhibition are due to the (fiber) antigen.Viruses related to adenovirus 15(Mastadenovirus h 15) showed a variety of cross-reactions in neutralization tests. In view of the new species definitions of adenoviruses and to facilitate identification, changes in the classification of Ad 15, 25, 29, and 15/H9 are proposed. The prototypes of Ad 13, 15, 25, 29, and 30 have been cloned by terminal dilution.Aided by a grant from the Bundesministerium für Jugend, Familie und Gesundheit.     

Dodecon,das lösliche Hämagglutinin bei allen Adenoviren der Untergruppe II

Zusammenfassung Die Sedimentationsraten der kompletten löslichen Hämagglutinine der Adenoviren wurden bei 16 Prototypen der Untergruppe II im Saccharose-Gradienten bestimmt. Die Werte waren für alle Viren ähnlich (65±10S). Dies bedeutet, daß die strukturellen Komponenten ebenfalls identisch sein dürften, also Dodecon (1).

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Dodecon, the soluble hemagglutinin present in all adenovirus types of subgroup II

Summary The sedimentation rate of the soluble complete hemagglutinins of 16 prototype adenoviruses of subgroup II were determined by means of sucrose gradient centrifugation. The rates were similar for all types (65±10S), thus indicating that the structural components may also be identicali.e. dodecon (1).

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Durchgeführt mit Unterstützung der Deutschen Forschungsgemeinschaft.     

Die Konzentration von Adenovirus-Antigenen mit Polyphosphors?ure

Zusammenfassung Mit Hilfe von Polyphosphaten lassen sich die Antigene von Adenovirus Typ 19 zeitsparend und schonend konzentrieren. In einem pH-Bereich zwischen 2,8 und 3,6 wurden bei Verwendung von 2 mg Polyphosphat je ml Antigen infektiöses Virus, Hämagglutinin und Adeno virus-Gruppen-antigen vollständig gefällt. Unter den gleichen Bedingungen wurde auch der größte Teil des Gesamtproteins und des komplementbindenden HeLa-Zellantigens präzipitiert, so daß man zwar eine Konzentrierung, aber keine Reinigung der virusspezifischen Komponenten erhält.

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Summary Antigens of adenovirus type 19 were concentrated by means of polyphosphate, a time-saving and mild procedure. Infectious virus, haemagglutinin and adenovirus group antigen were completely precipitated in a pH range between 2.8 and 3.6, when 2 mg. polyphosphate per ml. antigen was used. Under the same conditions, the bulk of total protein as well as of complement-fixing HeLa cell antigen was precipitated. Consequently, a concentration of virus-specific components was achieved, but no purification.

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Durchgeführt mit Unterstützung der Deutschen Forschungsgemeinschaft, Bad Godesberg.

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Herrn Prof. Dr.K. Herzberg zum 70. Geburtstag gewidmet.

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FrauI. Maurer und FräuleinI. Denker sei für ausgezeichnete technische Assistenz gedankt.