To freeze or not to freeze? Affective and cognitive perturbations have markedly different effects on postural control

Increasing Visual Biofeedback Scale Changes Postural Control Complexity

Visual biofeedback (vFB) during quiet stance has been shown to improve postural control. While this improvement has been quantified by a reduction in the center of pressure (COP) sway, the effect on COP complexity remains unexplored. As such, 20 young adults (12 females; aged 23.63 ± 3.17 years) were asked to remain in a static upright posture under different visual biofeedback magnitude (no feedback [NoFB], magnified by 1 [vFB1], magnified by 5 [vBF5] and magnified by 10 [vBF10]). In addition to confirming, through traditional COP variables (i.e. standard deviation, mean velocity, sway area), that vFB scaling improved postural control, results also suggested changes in COP complexity. Specifically, sample entropy and wavelet analysis showed that increasing the vFB scale from 1:1 to 1:5 and 1:10 led to a more irregular COP and a shift toward higher frequency. Together, and particularly from a complexity standpoint, these findings provided additional understandings of how vFB and vFB scaling improved postural control.

Muscle Recruitment Strategies in a Redundant Task: Age Differences Through Network Analyses

There are numerous studies comparing young and old adults in terms of muscle coordination in standard tasks (e.g., walking, reaching) and small variations of them. These tasks might hide differences: individuals would converge to similar behavior as they practice these throughout life. Also, we are unaware of studies that considered the muscle recruitment nested dynamics. For this reason, our study evaluated how young and old women coordinate and control the movement system while performing an unusual redundant motor control task through the network physiology approach. We acquired electromyographic signals from nine leg muscles of the dominant and non-dominant limbs during maximum voluntary isometric contractions (knee extension and flexion) and co-contraction bouts. Our results showed that young participants presented higher peak torque output, with similar EMG variability, compared to older participants. Considering firing rate frequencies, old and young women demonstrated different traits for network clustering and efficiency for the task. Age seems to affect muscle coordination at higher frequencies, even with a similar number of muscle synergies, indicating that younger women might have more integrated synergies than older women. The findings also point to differential muscle coordination adaptability.

Perceived cognitive fatigue has only marginal effects on static balance control in healthy young adults

We examined the influence of perceived cognitive fatigue on static balance control in healthy young adults to gain greater clarity about this issue than provided in previous research. Based on the prevailing assumption in pertinent literature, we hypothesized that the influence of cognitive fatigue on balance control depends on the attentional effort required by the balance tasks being performed. To test this hypothesis, 44 young adults (24 women and 20 men) were alternately assigned to either the experimental group that was cognitively fatigued (using the 16-min TloadDback-task with individualized settings) or the control group (who watched a documentary). Before and after the intervention, the participants performed six balance tasks that differed in (attentional) control requirements, while recording the center of pressure (COP). From these time series, sway variability, mean speed, and sample entropy were calculated and analyzed statistically. Additionally, perceived cognitive fatigue was assessed using VAS scales. Statistical analyses confirmed that the balance tasks differed in control characteristics and that cognitive fatigue was elevated in the experimental group, but not in the control group. Nevertheless, no significant main effects of cognitive fatigue were found on any of the COP measures of interest, except for some non-robust interaction effects related primarily to sample entropy. These results suggest that, in young adults, postural control in static balance tasks is largely automatic and unaffected by task-induced state fatigue.

Non-Linear Measures of Postural Control in Response to Painful and Non-Painful Visual Stimuli

Over the past decade, researchers have focused on studying the functional context of perceiving painful stimuli, particularly concerning the posturographic correlates of emotional processing. The aim of this study was to investigate the differential modulation of non-linear measures characterizing postural control in the context of perceiving painful stimuli. The study involved 36 healthy young participants who, while standing, viewed images depicting feet and hands in painful or non-painful situations, both actively (by imagining themselves affected by the situation) and passively. For Center of Pressure (COP) displacement, three non-linear measures (Sample Entropy, Fractal Dimension, and Lyapunov exponent) were calculated. The results suggest lower values of FD and LyE in response to active stimulation compared to those recorded for passive stimulation. Above all, our results pledge for the usefulness of the Lyapunov exponent for assessing postural modulation dynamics in response to painful stimuli perception. The feasibility of this calculation could provide an interesting insight in the collection of biomarkers related to postural correlates of emotional processes and their modulation in neurological disease where socio-affective functions can be often impaired before cognitive ones.

Posturography Approaches: An Insightful Window to Explore the Role of the Brain in Socio-Affective Processes

A significant amount of research has highlighted the importance of a motor component in the brain's processing of emotional, motivational and social information. Posturography has emerged as an interesting way to assess motor correlates associated with this process. In this review, we highlight recent results within the functional context of painful stimulus perception and discuss the interest in broadening the use of posturography to other motivational and societal functional contexts. Although characterized by significant feasibility, the single measurement of the COP's anteroposterior displacement presents limitations for attesting approach-avoidance behavior towards a visual target. Here, we discuss a number of methodological avenues that could go some way towards overcoming these limitations.

Scoping review of dual-task interference in individuals with intellectual disability

Dual-task paradigms can provide insights on the structures and mechanisms underlying information processing and hold diagnostic, prognostic, and rehabilitative value for populations with cognitive deficits such as in individuals with intellectual disability (ID). In this paradigm, two tasks are performed separately (single-task context) and concurrently (dual-task context). The change in performance from single- to dual-task context represents dual-task interference. Findings from dual-task studies have been largely inconsistent on whether individuals with ID present with dual-task-specific deficits. The current review aimed to map the published literature on dual-task methods and pattern of dual-task interference in individuals with ID. A scoping review based on Arksey and O'Malley's five-stage methodological framework was performed. Seventeen electronic databases and registries were searched to identify relevant studies, including gray literature. Charted data from included studies were analyzed quantitatively and qualitatively. PRISMA guidelines informed the reporting of this review. Twenty-two studies involving 1,102 participants (656 with ID and 446 without ID) met the review's inclusion criteria. Participants in the included studies were heterogeneous in sex, age (range 3-59 years), etiology and ID severity. Included studies characterized their ID-sample in different ways, most commonly using intelligence quotient (IQ) scores. Other measures of intellectual function (e.g., mental age, ID severity, verbal and/or visuospatial ability scores) were also used, either solely or in combination with IQ. Methods of dual-task testing varied across studies, particularly in relation to dual-task combinations, equation of single-task performance between groups, measurement and reporting of dual-task performance for each single-task, and task priority instructions. Thematic content of the included studies were: (1) structural interference to dual-tasking; (2) etiology-based differences in dual-tasking; (3) gait and balance dual-task performance; (4) testing executive function using dual-task paradigms; and (5) training effect on dual-task performance. Although the evidence consistently supported the intact dual-tasking ability of individuals with ID, the pattern of dual-task interference was inconsistent. Likewise, the evidence was inconclusive regarding dual-task deficit specific to individuals with ID because of heterogeneity in dual-task study designs among included studies.

Stepping strategies of young adults undergoing sudden external perturbation from different directions

Stepping strategies following external perturbations from different directions is investigated in this work. We analysed the effect of the perturbation angle as well as the level of awareness of individuals and characterised steps out of the sagittal plane between Loaded Side Steps (LSS), Unloaded Medial Steps (UMS) and Unloaded Crossover Steps (UCS). A novel experimental paradigm involving perturbations in different directions was performed on a group of 21 young adults (10 females, 11 males, 20-38 years). Participants underwent 30 randomised perturbations along 5 different angles with different levels of awareness of the upcoming perturbations (with and without wearing a sensory impairment device) for a total of 1260 recorded trials. Results showed that logistic models based on the minimal values of the Margin of Stability (MoS) or on the minimal values of the Time to boundary (Ttb) performed the best in the sagittal plane. However, their accuracy stayed above 79% regardless of the perturbation angle or level of awareness. Regarding the effect of the experimental condition, evidences of different balance recovery behaviours due to the variation of perturbation angles were exposed, but no significant effect of the level of awareness was observed. Finally, we proposed the Distance to Foot boundary (DtFb) as a relevant quantity to characterise the stepping strategies in response to perturbations out of the sagittal plane.

Variability of Postural Coordination in Dual-Task Paradigm

Postural control is influenced by cognition. In most studies, variability of motor output has been considered regardless of variability in patterns of joint coordination. Uncontrolled manifold framework has been applied to decompose the joint's variance in two components. The first component leaves position of the center of mass in anterior-posterior direction (CoMAP) unchanged (VUCM) while the second component is in charge of variations of CoM (VORT). In this study, 30 healthy young volunteers were recruited. The experimental protocol consisted of three random conditions: quiet standing on a narrow wooden block without a cognitive task (NB), quiet standing on a narrow wooden block with an easy cognitive task (NBE), and quiet standing on a narrow wooden block with a difficult cognitive task (NBD). Results showed that CoMAP sway in NB condition was higher than both NBE and NBD conditions (p = .001). VORT in NB condition was higher than NBE and NBD conditions (p = .003). VORT in NB condition was higher than NBE and NBD conditions (p = .003). VUCM was unchanged in all conditions (p = 1.00) and synergy index in NB condition was smaller than NBE and NBD conditions (p = .006). These results showed that postural synergies increased under dual-task conditions.

Postural threat increases sample entropy of postural control

Introduction

Postural threat elicits modifications to standing balance. However, the underlying neural mechanism(s) responsible remain unclear. Shifts in attention focus including directing more attention to balance when threatened may contribute to the balance changes. Sample entropy, a measure of postural sway regularity with lower values reflecting less automatic and more conscious control of balance, may support attention to balance as a mechanism to explain threat-induced balance changes. The main objectives were to investigate the effects of postural threat on sample entropy, and the relationships between threat-induced changes in physiological arousal, perceived anxiety, attention focus, sample entropy, and traditional balance measures. A secondary objective was to explore if biological sex influenced these relationships.

Methods

Healthy young adults (63 females, 42 males) stood quietly on a force plate without (No Threat) and with (Threat) the expectation of receiving a postural perturbation (i.e., forward/backward support surface translation). Mean electrodermal activity and anterior-posterior centre of pressure (COP) sample entropy, mean position, root mean square, mean power frequency, and power within low (0-0.05 Hz), medium (0.5-1.8 Hz), and high-frequency (1.8-5 Hz) components were calculated for each trial. Perceived anxiety and attention focus to balance, task objectives, threat-related stimuli, self-regulatory strategies, and task-irrelevant information were rated after each trial.

Results and Discussion

Significant threat effects were observed for all measures, except low-frequency sway. Participants were more physiologically aroused, more anxious, and directed more attention to balance, task objectives, threat-related stimuli, and self-regulatory strategies, and less to task-irrelevant information in the Threat compared to No Threat condition. Participants also increased sample entropy, leaned further forward, and increased the amplitude and frequency of COP displacements, including medium and high-frequency sway, when threatened. Males and females responded in the same way when threatened, except males had significantly larger threat-induced increases in attention to balance and high-frequency sway. A combination of sex and threat-induced changes in physiological arousal, perceived anxiety, and attention focus accounted for threat-induced changes in specific traditional balance measures, but not sample entropy. Increased sample entropy when threatened may reflect a shift to more automatic control. Directing more conscious control to balance when threatened may act to constrain these threat-induced automatic changes to balance.

The Effects of Conscious Movement Processing on the Neuromuscular Control of Posture

Maintaining balance is thought to primarily occur sub-consciously. Occasionally, however, individuals will direct conscious attention towards balance, e.g., in response to a threat to balance. Such conscious movement processing (CMP) increases the reliance on attentional resources and may disrupt balance performance. However, the underlying changes in neuromuscular control remain poorly understood. We investigated the effects of CMP (manipulated using verbal instructions) on neural control of posture in twenty-five adults (11 females, mean age = 23.9, range = 18-33). Participants performed 90-s, bipedal stance balance trials in high- and low-CMP conditions, during both stable (solid surface) and unstable (foam) task conditions. Postural sway amplitude, frequency and complexity were used to assess postural control. Surface EMG was recorded bilaterally from lower leg muscles (Soleus, Tibialis Anterior, Gastrocnemius Medialis, Peroneus Longus) and intermuscular coherence (IMC) was assessed for 12 muscle pairs across four frequency bands. We observed significantly increased sway amplitude, and decreased sway frequency and complexity in the high- compared to the low-CMP conditions. All sway variables increased in the unstable compared to the stable conditions. We observed reduced beta band IMC between several muscle pairs during high- compared to low-CMP, but these findings did not remain significant after controlling for multiple comparisons. Finally, IMC significantly increased in the unstable conditions for most muscle combinations and frequency bands. In all, results tentatively suggest that CMP-induced changes in sway outcomes may be facilitated by reduced beta-band IMC, but these findings need to be replicated before they can be interpreted more conclusively.

Athletes with intellectual disability: The effects of cognitive deficits and sports practice on bipedal standing balance

BACKGROUND

Athletes with intellectual disability represent a unique population who experiences the contrasting effects of cognitive deficits and benefits of sports on balance. This study investigated the combined impact of intellectual disability and sport practice on balance.

METHOD

Center-of-pressure excursion in bipedal stance of 2 disability (with and without intellectual disability) × 2 sport practice (athlete and novice) participant groups was measured in several balance conditions.

RESULTS

Sport practice exerted no significant effect on any of the center-of-pressure measures used. In contrast, intellectual disability's effects on balance, which were most apparent in challenging balance conditions, were significant (p < .05) and had large effect sizes (η_p ²  > 0.13).

CONCLUSION

The negative effects of cognitive deficits on the balance of young adults with intellectual disability underscore the need for effective interventions. Although findings did not support sports' balance-remediating potential, the value of sport participation for individuals with intellectual disability cannot be fully dismissed just yet.

Inter-Individual Variability in Postural Control During External Center of Mass Stabilization

Understanding the relation between the motion of the center of mass (COM) and the center of pressure (COP) is important to understand the underlying mechanisms of maintaining body equilibrium. One way to investigate this is to stabilize COM by fixing the joints of the human and looking at the corresponding COP reactions. However, this approach constrains the natural motion of the human. To avoid this shortcoming, we stabilized COM without constraining the joint movements by using an external stabilization method based on inverted cart-pendulum system. Interestingly, this method only stabilized COM of a subgroup of participants and had a destabilizing effect for others which implies significant variability in inter-individual postural control. The aim of this work was to investigate the underlying causes of inter-individual variability by studying the postural parameters of quiet standing before the external stabilization. Eighteen volunteers took part in the experiment where they were standing on an actuated cart for 335 s. In the middle of this period we stabilized their COM in anteroposterior direction for 105 s. To stabilize the COM, we controlled the position of the cart using a double proportional–integral–derivative controller. We recorded COM position throughout the experiment, calculated its velocity, amplitude, and frequency during the quiet standing before the stabilization, and used these parameters as features in hierarchical clustering method. Clustering solution revealed that postural parameters of quiet standing before the stabilization cannot explain the inter-individual variability of postural responses during the external COM stabilization. COM was successfully stabilized for a group of participants but had a destabilizing effect on the others, showing a variability in individual postural control which cannot be explained by postural parameters of quiet-stance.

Influence of age on postural control during dual task: a centre of pressure motion and electromyographic analysis

BACKGROUND

Dual task influences postural control. A cognitive task seems to reduce muscle excitation during a postural balance, especially in older adults (OA).

AIM

The aim of this study is to evaluate the effect of three cognitive tasks on muscle excitation and static postural control in OA and young adults (YA) in an upright posture maintenance task.

METHODS

31 YA and 30 OA were evaluated while performing a modified Romberg Test in five different conditions over a force plate: open eyes, closed eyes, spatial-memory brooks' test, counting backwards aloud test and mental arithmetic task. The surface electromyographic signals of Tibialis anterior (TA), Lateral Gastrocnemius (GL), Peroneus Longus (PL), and Erector Spinae (ES) was acquired with an 8-channel surface electromyographic system. The following variables were computed for both the electromyographic analysis and the posturographic assessment: Root mean square (RMS), centre of pressure (CoP) excursion (Path) and velocity, sway area, RMS of the CoP Path and 50%, 95% of the power frequency. Mixed ANOVA was used to detect differences with group membership as factor between and type of task as within. The analysis was performed on the differences between each condition from OE.

RESULTS

An interaction effect was found for Log (logarithmic) Sway Area. A main effect for task emerged on all posturographic variables except Log 95% frequencies and for Log PL and ES RMS. A main effect for group was never detected.

DISCUSSION AND CONCLUSION

This study indicates a facilitating effect of mental secondary task on posturographic variables. Non-silent secondary task causes increase in ES and TA muscle activation and a worsening in static postural control performance.

Are You “Gazing” at Me? How Others' Gaze Direction and Facial Expression Influence Gaze Perception and Postural Control

In everyday life, interactions between humans are generally modulated by the value attributed to the situation, which partly relies on the partner's behavior. A pleasant or cooperating partner may trigger an approach behavior in the observer, while an unpleasant or threatening partner may trigger an avoidance behavior. In this context, the correct interpretation of other's intentions is crucial to achieve satisfying social interactions. Social cues such as gaze direction and facial expression are both fundamental and interrelated. Typically, whenever gaze direction and facial expression of others communicate the same intention, it enhances both the interlocutor's gaze direction and the perception of facial expressions (i.e., shared signal hypothesis). For instance, an angry face with a direct gaze is perceived as more intense since it represents a threat to the observer. In this study, we propose to examine how the combination of others' gaze direction (direct or deviated) and emotional facial expressions (i.e., happiness, fear, anger, sadness, disgust, and neutrality) influence the observer's gaze perception and postural control. Gaze perception was indexed by the cone of direct gaze (CoDG) referring to the width over which an observer feels someone's gaze is directed at them. A wider CoDG indicates that the observer perceived the face as looking at them over a wider range of gaze directions. Conversely, a narrower CoDG indicates a decrease in the range of gaze directions perceived as direct. Postural control was examined through the center of pressure displacements reflecting postural stability and approach-avoidance tendencies. We also investigated how both gaze perception and postural control may vary according to participants' personality traits and emotional states (e.g., openness, anxiety, etc.). Our results confirmed that gaze perception is influenced by emotional faces: a wider CoDGs was observed with angry and disgusted faces while a narrower CoDG was observed for fearful faces. Furthermore, facial expressions combined with gaze direction influence participants' postural stability but not approach-avoidance behaviors. Results are discussed in the light of the approach-avoidance model, by considering how some personality traits modulate the relation between emotion and posture.

The autonomy and focus of attention strategies under distraction: Frequency and sample entropy analyses in a dynamic balance task

An external focus of attention has been shown to be effective in balance tasks. However, replication in applied settings is limited. The OPTIMAL theory proposes that a combination of autonomy and external focus increases focus to the task goal, and therefore more effective than external focus alone. However, research suggests that the combined effect is limited in discrete skills, and the increased focus effect is only reported by subjective assessment. The present study examined the effect of the combined strategy and its effect of "increased focus" compared to external focus and control groups under distraction. In experiment 1, participants (N = 60) practiced eight 35 s trials on a stabilometer followed by a 10 min-delayed retention test and an auditory distraction transfer test. The combined group chose a tape color to place on a stabilometer and was told to "keep the tapes parallel to the floor," the external focus group was yoked with the combined group, and the control group was told to "do your best". Performance was measured in Root Mean Square Error (RMSE). The increased focus effect was examined by both subjective (distraction score, a question about participants' perceptions) and objective (Mean Power Frequency, MPF, Sample entropy, SampEn) methods. Although participants improved significantly (p < .05), group differences were not observed during retention (p's > 0.05). An increased focus effect of the combined effect was not observed in any variables (p's > 0.05). In experiment 2, the practice duration was extended to replicate previous study designs (i.e., 90s trials; 2 days of practice; 24 h retention test; the number of participants). Consistent with experiment 1, group differences were not evident in RMSE, SampEn, and MPF (p's > 0.05). We suggest that autonomy may be required to be task-relevant, and simply telling to do best may be as useful as external focus or combined strategies in a continuous balance task. Further, the analysis showed that SampEn increased on Day 1 but decreased on Day 2, and MPF decreased within a session, but the average MPF increased by the day. Potential explanations and future directions when utilizing these metrics are discussed.

Postural sway in the moving room scenario: New evidence for functional dissociation between self-motion perception and postural control

Postural control in quiet standing is often explained by a reflexive response to optical flow, the apparent motion of environmental objects in a visual scene. However, moving room experiments show that even small-amplitude body sway can evoke odd sensations or motion sickness, indicating that a consciousness factor may also be involved. Studies targeting perception of self-motion, vection, typically use rapid visual stimuli moving in a single direction to maintain a constant feeling of vection, and there are few studies of vection using low-speed sinusoidal visual stimuli similar to human pendular movement. In the present study we searched for changes in postural control during periods of vection during quiet standing. Participants (N = 19, age = 20.4 ±1.1 years) were shown dynamic visual stimuli in the form of sinusoidally expanding and contracting random dots, and the stimuli speed and visual field were manipulated. Posture was continually evaluated using Center of Pressure (CoP) measurements. Participants were also asked to report feelings of vection, both by pressing a button during the trial and through an overall rating at the end of each trial. Using repeated-measures ANOVA, we assessed changes in the CoP and vection variables between experimental conditions, as well as possible interactions between the variables. The results show that postural reaction and vection were both affected by the visual stimuli and varied with speed. The peripheral visual field was found to couple to stronger feeling of vection and better quality of postural control. However, no significant relationship between postural control and vection, nor evidence of vection interaction to the relationship between optical flow and postural control, was found. Based on our results we conclude that for postural stability during quiet standing, visual cues dominate over any potential consciousness factor arising due to vection.

On the physiology of interruption after unexpectedness

We tested whether surprise elicits similar physiological changes as those associated with orienting and freezing after threat, as surprise also involves a state of interruption and attention for effective action. Moreover, because surprise is primarily driven by the unexpectedness of an event, initial physiological responses were predicted to be similar for positive, neutral, and negative surprises. Results of repetition-change studies (4 + 1 in Supplemental Materials) showed that surprise lowers heart rate (Experiments 1-4) and increases blood pressure (Experiment 4). No effects on body movement (Experiment 2) or finger temperature (Experiment 4) were found. When unexpected stimuli were presented more often (making them less surprising) heart rate returned to baseline, while blood pressure remained high (Experiment 4). These effects were not influenced by stimulus valence. However, second-to-second analyses within the first (surprising) block showed a tendency for a stronger increase in systolic blood pressure after negative vs. positive surprise.

Differences in static postural control between top level male volleyball players and non-athletes

It is argued that elite athletes often demonstrate superior body balance. Despite the apparent significance of perfect balance ability in volleyball, little is known about the specific nature of postural control adjustments among first-rate volleyball competitors. This study compared postural performance and strategies in quiet stance between world vice-champions and young, healthy, physically active male subjects. The center-of-pressure (COP) signals recorded on a force plate were used to compute several measures of sway. In both axes of movement, athletes had lower COP range, but not its standard deviation and higher COP speed and frequency than controls. These findings indicate that postural regulation in athletes was more precise and less vulnerable to external disturbances which support optimal timing and precision of actions. Postural strategies in athletes standing quietly were similar to those exhibited by non-athletes performing dual tasks. It demonstrates a significant effect of sport practice on changes in postural control. In anterior–posterior axis, athletes displayed a much higher COP fractal dimension and surprisingly lower COP–COG frequency than controls. This accounts for their high capacity to use diversified postural strategies to maintain postural stability and significantly reduced the contribution of proprioception to save this function for carrying out more challenging posture-motor tasks.

Effect of Light Finger Touch, a Cognitive Task, and Vision on Standing Balance in Stroke

The aim of the exploratory study was to investigate the individual and combined effects of light finger touch, a cognitive task, and vision on postural sway in individuals with stroke. Nine older adults with stroke stood on the force platform with eyes open and eyes closed, with and without a light finger touch contact with the stationary frame, and when counting backward from a randomly chosen three-digit number or without it. The center of pressure (COP) excursion, velocity, range and sway area was calculated. Participants demonstrated significantly larger postural sway when vision was not available (p < 0.05), smaller postural sway when using a finger touch contact (p < 0.05), and increased postural sway while performing the cognitive task (p < 0.05). When finger touch and a cognitive task was performed simultaneously, body sway decreased as compared to standing and performing a cognitive task in eyes open (p < 0.05) and eyes closed conditions. Results indicate that light touch in individuals with stroke mitigates the impact of cognitive load. The findings contribute to the understanding of the role of sensory integration in balance control of individuals with neurological impairments and older adults.

Number of Trials Needed to Assess Postural Control of Young Adults in Single and Dual-Task

Despite its popularity, there is a lack of standardization when assessing postural control. This study aimed to suggest how many trials should be used when assessing young adults' postural control with a specific single-task and dual-task quiet stance protocol. Two groups of 15 participants performed 20 trials of 60 s (feet together, eyes open) with or without a dual-task. The number of trials needed to obtain two consecutive intra-class correlation coefficients (ICC(2,k)) ≥0.900 was then assessed for seven center of pressure variables. Although inconsistency was observed between variables and tasks, five trials seems to be a good compromise.

Distinguishing Two Types of Variability in a Sit-to-Stand Task

Variability is commonly observed in complex behavior, such as the maintenance of upright posture. The current study examines the value added by using nonlinear measures of variability to identify dynamic stability instead of linear measures that reflect average fluctuations about a mean state. The largest Lyapunov exponent (λ1) and SD were calculated on mediolateral movement as participants performed a sit-to-stand task on a stable and unstable platform. Both measures identified changes in movement across postures, but results diverged when participants stood on the unstable platform. Large SD indicated an increase in movement variability, but small λ1 identified those movements as stable and controlled. The results suggest that a combination of linear and nonlinear analyses is useful in identifying the proportion of observed variability that may be attributed to structured, controlled sources. Nonlinear measures of variability, like λ1, can further be used to make predictions about transitions between stable postures and to identify a system’s resistance to disruption from external perturbations. Those features make nonlinear analyses highly applicable to both human movement research and clinical practice.

Should the Minimal Intervention Principle Be Considered When Investigating Dual-Tasking Effects on Postural Control?

Dual-tasking charges the sensorimotor system with performing two tasks simultaneously. Center of pressure (COP) analysis reveals the postural control that is altered during dual-tasking, but may not reveal the underlying neural mechanisms. In the current study, we hypothesized that the minimal intervention principle (MIP) provides a concept by which dual-tasking effects on the organization and prioritization of postural control can be predicted. Postural movements of 23 adolescents (age 12.7 ± 1.3; 8 females) and 15 adults (26.9 ± 2.3) were measured in a bipedal stance with eyes open, eyes closed and eyes open while performing a dual-task using a force plate and 39 reflective markers. COP data was analyzed by calculating the mean velocity, standard deviation and amplitude of displacement. Kinematic data was examined by performing a principal component analysis (PCA) and extracting postural movement components. Two variables were determined to investigate changes in amplitude (aVark) and in control (Nk) of the principal movement components. Results in aVark and in Nk agreed well with the predicted dual-tasking effects. Thus, the current study corroborates the notion that the MIP should be considered when investigating postural control under dual-tasking conditions.

The interplay between cognitive tasks and vision for upright posture balance in adolescents

Background

The control of an upright stance in humans is important in medicine, psychology, and physiology. The maintenance of upright stance balance depends not only on sensory information from proprioceptive, vestibular, cutaneous, and visual sources but also on cognitive resources. The present study investigated the effects of cognitive tasks while standing with eyes open on upright stance balance in adolescents. We hypothesized that performing a cognitive task while standing with eyes open would increase body sway among these adolescents and that the upright posture would thus become less stable.

Methods

A static balance assessment system comprising a force platform connected to a computer was used to evaluate the stability of the upright stance among 21 healthy adolescents under six conditions: no cognitive task, a relatively easy cognitive task, or the same cognitive task made more difficult, with each task being performed while the eyes were open and again while the eyes were closed. The participants performed mental calculations as fast as possible by subtracting either 3 or 18 from a random three-digit number continuously, for the simple cognitive task or the difficult cognitive task, respectively. Each calculation was completed within 10 s. The evaluation indexes used to measure upright posture stability were the root mean square (RMS) of the total body sway in the mediolateral and anteroposterior directions, the mean velocity (MV) value of the total body sway, and the Romberg quotient (RQ) of these values.

Results

The RMS (p < 0.01) and MV (p < 0.01) values of the upright posture sway were lower when participants performed no cognitive task and their eyes were open than when their eyes were closed. When their eyes were open, compared with no cognitive task, the values of the measures evaluating upright posture sway were higher, meaning the stance was less stable, while performing either the simple or the more difficult cognitive task (RMS: simple task, p < 0.01; difficult task, p < 0.05; MV: simple task, p < 0.01; difficult task, p < 0.01) although no significant differences were detected for the RMS or MV values between the simple and more difficult cognitive tasks. The RQs for both the RMS and the total MV values of the upright posture sway during performance of the difficult cognitive task were significantly lower than when the participants performed no task.

Conclusion

Performance of a cognitive task significantly reduced the upright posture balance in adolescents during eyes open although increased task difficulty did not show a greater effect. The interference between the performance of a cognitive task and the visual control of an upright stance may be attributable in part to cognitive and visual processing streams competing for common central resources, consistent with the Multiple Resource Theory of information processing.

Cognitive task modality influences postural control during quiet standing in healthy older adults

BACKGROUND

The interstimulus interval of a cognitive task was found to have a limited effect on postural control in young adults, while visual cognitive tasks were found to improve stability compared to auditory tasks. It is of interest to investigate whether postural control in healthy older adults is sensitive to these types of cognitive task manipulations.

AIMS

The objectives of the present experiment were to evaluate the impact of interstimulus interval and modality of a continuous cognitive task on postural control in healthy older adults.

METHODS

Fifteen healthy older adults (70 ± 3.2 years, 3 male) were asked to stand with feet together on a force platform while performing auditory and visual cognitive tasks performed with interstimulus intervals of 2 and 5 s.

RESULTS

Visual tasks led to reductions in sway area and sway variability in the anterior-posterior direction compared to auditory tasks (ps ≤ 0.05). The interstimulus interval did not lead to a change in sway, except for a small change in the medial-lateral direction for the 2-s interval compared to the 5-s interval (p = 0.05).

DISCUSSION AND CONCLUSIONS

Results suggest that the interstimulus interval had a very limited effect on postural sway. The modality of the cognitive task had a greater effect on postural sway, as visual cognitive tasks yielded smaller sway area and anterior-posterior sway variability than auditory conditions. Visual stimuli may have acted as an anchor, yielding reduced sway.

Small, movement dependent perturbations substantially alter postural control strategy in healthy young adults

Postural control is commonly investigated by observing responses to perturbations. We developed a perturbation paradigm mimicking self-generated errors in weight shifting, which are a common cause of falling among older adults. Our aim was to determine the effects of this small, but complex, perturbation on postural sway of healthy young adults and evaluate the role of vision and cognition during movement dependent perturbations. Fifteen participants stood hip-width apart with their eyes open, closed and while performing two different cognitive tasks. Participants were continuously perturbed by medial-lateral (ML) support surface translations corresponding to, and hence doubling, their own center of mass sway. We analyzed the standard deviation (SD), root mean square (RMS), range, and mean power frequency (MPF) of center of pressure displacements. ML postural sway increased due to the perturbation (SD p ≤ .001, range p < .001, RMS p ≤ .001, MPF p < .001). Cognitive load increased the ML sway range (p = .048). Lack of vision increased ML MPF (p = .001) and anterior-posterior (AP) range (p < .001), SD (p < .001), and RMS (p = .001). Significant interaction of vision with the perturbation was found for the ML range (p = .045) and AP SD (p = .018). The perturbation specifically affected ML postural sway. Increased MPF is indicative of a postural control strategy change, which was insufficient for fully controlling the increased sway. Despite being small, this type of perturbation appears to be challenging for young adults.

Absence of Ankle Stiffening While Standing in Focus and Cognitive Task Conditions in Older Adults

Research suggests that an external focus or cognitive task may improve postural control. Removing attention from movement production may promote automaticity, or the tasks may promote ankle stiffening. To investigate these two theories, twenty older adults stood while performing baseline standing, internal focus, external focus, and two cognitive tasks. Changes in postural control occurred in external focus and cognitive task conditions compared to baseline and internal focus, while no change occurred in cocontraction indices. This suggests that an external focus and cognitive task can improve postural control in older adults. Since no change occurred in cocontraction indices across conditions, this suggests that stiffening cannot explain these changes. Instead, changes could be due to automaticity of sway.

The Effect of Cognitive Resource Competition Due to Dual-Tasking on the Irregularity and Control of Postural Movement Components

Postural control research suggests a non-linear, n-shaped relationship between dual-tasking and postural stability. Nevertheless, the extent of this relationship remains unclear. Since kinematic principal component analysis has offered novel approaches to study the control of movement components (PM) and n-shapes have been found in measures of sway irregularity, we hypothesized (H1) that the irregularity of PMs and their respective control, and the control tightness will display the n-shape. Furthermore, according to the minimal intervention principle (H2) different PMs should be affected differently. Finally, (H3) we expected stronger dual-tasking effects in the older population, due to limited cognitive resources. We measured the kinematics of forty-one healthy volunteers (23 aged 26 ± 3; 18 aged 59 ± 4) performing 80 s tandem stances in five conditions (single-task and auditory n-back task; n = 1–4), and computed sample entropies on PM time-series and two novel measures of control tightness. In the PM most critical for stability, the control tightness decreased steadily, and in contrast to H3, decreased further for the younger group. Nevertheless, we found n-shapes in most variables with differing magnitudes, supporting H1 and H2. These results suggest that the control tightness might deteriorate steadily with increased cognitive load in critical movements despite the otherwise eminent n-shaped relationship.

Thinking on your feet: An analysis of movement and cognition in a sit to stand task

The maintenance of upright posture involves constant adjustment to external and internal perturbations. This balancing act is often assumed to be an automatic process, but studies suggest that cognitive processes, particularly attention, are necessary for the control of posture. The current study examines the role of attention in balance using a dual-task paradigm. Twenty-four healthy young adults performed a sit-to-stand (STS) task on either a stable or unstable platform while performing a secondary cognitive task of counting backwards aloud. Movement of the upper and lower body was analyzed using the largest Lyapunov exponent (λ₁) and standard deviation (SD). Results replicated earlier findings (Gibbons, Amazeen, & Likens, 2018) that the transition from sit to stand was marked by increased variability and a temporary destabilization of postural control. Participants exhibited greater movement variability overall on the unstable platform (large SD), but small λ₁ indicated that movement was controlled. During second task performance, SD increased for the upper body only. Further research is necessary to understand the interaction between attention and balance in young adults.

Acute effects of contract-relax proprioceptive neuromuscular facilitation stretching of hip abductors and adductors on dynamic balance

Background

Balance control has been shown to play a fundamental role both in everyday life and many athletic activities. An important component of balance control is the somatosensory information gained from muscle spindles and Golgi tendon organs. The changes in the muscle-tendon unit stiffness could alter the ability to detect and respond promptly to changes of an unstable environment. One of the procedures affecting muscle stiffness is stretching, and contract-relax PNF stretching (CRS) is considered as one of the safest and most effective techniques. So far, there are no studies on the impact of CRS of hip adductor and abductor muscles on body balance. These muscle groups are responsible for maintaining mediolateral balance which is of particular interest, since it is more affected by ageing and disease and since its deterioration has been associated with an increased risk of falling. In light of the above, the aim of the present study was to investigate the effects of a single dose of contract-relax proprioceptive neuromuscular facilitation stretching of hip adductors and abductors on mediolateral dynamic balance.

Methods

The study involved 45 healthy individuals (age 19–23 years) assigned to the intervention group (IG) or the control group (CG). Balance testing was carried out before (Pre) and immediately after CRS in the intervention group or after 5-minute rest in the control group (Post). There were performed three repetitions of the CRS targeting the adductor and abductor muscles of the hip.

Results

Statistically significant differences between Pre and Post condition were observed only in the intervention group. The values of all measured variables defining the body’s dynamic balance were significantly lower immediately after the applied CRS, which indicates an improved body balance: Global Index (p = 0.0001), total area of sway (p = 0.0001), external area of sway (p = 0.00004), external time (p = 0.0004) and reaction time (p = 0.0003).

Conclusions

A single dose of contract-relax proprioceptive neuromuscular facilitation stretching of the hip adductor and abductor muscles improved mediolateral dynamic balance.

New Insights on Emotional Contributions to Human Postural Control

It has been just over 20 years since the effects of height-induced threat on human postural control were first investigated. Raising the height of the support surface on which individuals stood increased the perceived consequences of instability and generated postural control changes. Since this initial work, converging evidence has accumulated supporting the efficacy of using height-induced threat to study the effects of emotions on postural control and confirming a direct influence of threat-related changes in arousal, anxiety, and fear of falling on all aspects of postural control, including standing, anticipatory, and reactive balance. In general, threat-related postural changes promote a greater physical safety margin while maintaining upright stance. We use the static balance literature to critically examine the current state of knowledge regarding: (1) the extent to which threat-related changes in postural control are sensitive to threat-related changes in emotions; (2) the underlying neurophysiological and cognitive mechanisms that may contribute to explaining the relationship between emotions and postural control; and (3) the generalizability of threat-related changes across different populations and types of threat. These findings have important implications for understanding the neuromechanisms that control healthy balance, and highlight the need to recognize the potential contributions of psychological and physiological factors to balance deficits associated with age or pathology. We conclude with a discussion of the practical significance of this research, its impact on improving diagnosis and treatment of postural control deficits, and potential directions for future research.

Improvements in Obstacle Clearance Parameters and Reaction Time Over a Series of Obstacles Revealed After Five Repeated Testing Sessions in Older Adults

The purpose of this study was to investigate obstacle clearance and reaction time parameters when crossing a series of six obstacles in older adults. A second aim was to examine the repeated exposure of this testing protocol once per week for 5 weeks. In total, 10 older adults (five females; age: 67.0 ± 6.9 years) walked onto and over six obstacles of varying heights (range: 100-200 mm) while completing no reaction time, simple reaction time, and choice reaction time tasks once per week for 5 weeks. The highest obstacles elicited the lowest toe clearance, and the first three obstacles revealed smaller heel clearance compared with the last three obstacles. Dual tasking negatively impacted obstacle clearance parameters when information processing demands were high. Longer and less consistent time to completion was observed in Session 1 compared with Sessions 2-5. Finally, improvements in simple reaction time were displayed after Session 2, but choice reaction time gradually improved and did not reach a plateau after repeated testing.

Attentional demands associated with augmented visual feedback during quiet standing

To investigate how additional visual feedback (VFB) affects postural stability we compared 20-sec center-of-pressure (COP) recordings in two conditions: without and with the VFB. Seven healthy adult subjects performed 10 trials lasting 20 seconds in each condition. Simultaneously, during all trials the simple auditory reaction time (RT) was measured. Based on the COP data, the following sway parameters were computed: standard deviation (SD), mean speed (MV), sample entropy (SE), and mean power frequency (MPF). The RT was higher in the VFB condition (p < 0.001) indicating that this condition was attention demanding. The VFB resulted in decreased SD and increased SE in both the medial-lateral (ML) and anterior-posterior (AP) planes (p < .001). These results account for the efficacy of the VFB in stabilizing posture and in producing more irregular COP signals which may be interpreted as higher automaticity and/or larger level of noise in postural control. The MPF was higher during VFB in both planes as was the MV in the AP plane only (p < 0.001). The latter data demonstrate higher activity of postural control system that was caused by the availability of the set-point on the screen and the resulting control error which facilitated and sped up postural control.

Effects of breathing movement on the reduction of postural sway during postural-cognitive dual tasking

An execution of cognitive processing interferes with postural sway during quiet standing. It reduces sway variability in young adults, but the mechanism is not clear. To elucidate the mechanisms, we focused on breathing in the present study. The purpose of this study was to clarify whether a decrease in postural sway amplitude during a postural-cognitive task is related to the change in breathing movement. The center of pressure (COP) was recorded via a force plate and the motion of leg joints (ankle, knee, and hip), and breathing movements were measured with a 3D motion capture system in quiet standing and standing with cognitive (mental arithmetic) task conditions. The change ratios of each variable from the quiet standing condition to the cognitive task were also calculated. It was shown that the MASt condition produced a significantly smaller RMS of COP displacement as compared to the QSt condition (p < 0.01). The results revealed that the breathing rate was faster and the amplitude of breathing movement smaller when subjects performed the cognitive task. A significant positive correlation (r = 0.75, p < 0.01) was found between the change ratio of breathing amplitude and the COP amplitude. The present results suggest that reduced standing postural sway during a cognitive task is related, at least in part, to a decrease in breathing amplitude.

Exploring the relationship between threat-related changes in anxiety, attention focus, and postural control

Individuals report directing attention toward and away from multiple sources when standing under height-related postural threat, and these changes in attention focus are associated with postural control modifications. As it is unknown whether these changes generalize to other types of threat situations, this study aimed to quantify changes in attention focus and examine their relationship with postural control changes in response to a direct threat to stability. Eighty young adults stood on a force plate fixed to a translating platform. Three postural threat conditions were created by altering the expectation of, and prior experience with, a postural perturbation: no threat of perturbation, threat without perturbation experience, and threat with perturbation experience. When threatened, participants were more anxious and reported directing more attention to movement processes, threat-related stimuli, and self-regulatory strategies, and less to task-irrelevant information. Postural sway amplitude and frequency increased with threat, with greater increases in frequency and smaller increases in amplitude observed with experience. Without experience, threat-related changes in postural control were accounted for by changes in anxiety; larger changes in anxiety were related to larger changes in sway amplitude. With experience, threat-related postural control changes were accounted for by changes in attention focus; increases in attention to movement processes were related to greater forward leaning and increases in sway amplitude, while increases in attention to self-regulatory strategies were related to greater increases in sway frequency. Results suggest that relationships between threat-related changes in anxiety, attention focus, and postural control depend on the context associated with the threat.

A robotic system for delivering novel real-time, movement dependent perturbations

Perturbations are often used to study movement control and balance, especially in the context of falling. Most often, discrete perturbations defined prior to the experiment are used to mimic external disturbances to balance. However, the largest proportion of falls is due to self-generated errors in weight shifting. Inspired by self-generated weight shifting errors, we created a novel, continuous mediolateral perturbation proportional to subjects' mediolateral center of mass movement with minimal delays. This perturbation was delivered by a robotic platform controlled by a real time Matlab Simulink model using kinematic data from a marker positioned at subjects' L5 as input. Fifteen healthy young adults stood as still as possible atop the robotic platform with their eyes closed. We evaluated the performance of the perturbation in terms of accuracy and delay relative to the input signal by using cross-correlations. The perturbations were accurate (r=-0.984), with delays of 154 ms. Such systematic perturbation significantly affected mediolateral sway, increasing its range (from 5.56±3.72 to 9.58 ±4.83 mm, p=0.01), SD (from 1.08±0.74 to 1.72±0.74 mm, p = 0.02), and mean power frequency (from 0.08±0.05 to 0.25±0.17 Hz, p<0.01). These perturbation characteristics enable inducing systematic, movement-dependent perturbations and open the door for future studies investigating self-generated movement errors.

The effect of fear of falling on vestibular feedback control of balance

Vestibular sensation contributes to cervical‐head stabilization and fall prevention. To what extent fear of falling influences the associated vestibular feedback processes is currently undetermined. We used galanic vestibular stimulation (GVS) to induce vestibular reflexes while participants stood at ground level and on a narrow walkway at 3.85 m height to induce fear of falling. Fear was confirmed by questionnaires and elevated skin conductance. Full‐body kinematics was measured to differentiate the whole‐body centre of mass response (CoM) into component parts (cervical, axial trunk, appendicular short latency, and medium latency). We studied the effect of fear of falling on each component to discern their underlying mechanisms. Statistical parametric mapping analysis provided sensitive discrimination of early GVS and height effects. Kinematic analysis revealed responses at 1 mA stimulation previously believed marginal through EMG and force plate analysis. The GVS response comprised a rapid, anode‐directed cervical‐head acceleration, a short‐latency cathode‐directed acceleration (cathodal buckling) of lower extremities and pelvis, an anode‐directed upper thorax acceleration, and subsequently a medium‐latency anode‐directed acceleration of all body parts. At height, head and upper thorax early acceleration were unaltered, however, short‐latency lower extremity acceleration was increased. The effect of height on balance was a decreased duration and increased rate of change in the CoM acceleration pattern. These results demonstrate that fear modifies vestibular control of balance, whereas cervical‐head stabilization is governed by different mechanisms unaffected by fear of falling. The mechanical pattern of cathodal buckling and its modulation by fear of falling both support the hypothesis that short‐latency responses contribute to regulate balance.

Cognitive tasks promote automatization of postural control in young and older adults

Researchers looking at the effects of performing a concurrent cognitive task on postural control in young and older adults using traditional center-of-pressure measures and complexity measures found discordant results. Results of experiments showing improvements of stability have suggested the use of strategies such as automatization of postural control or stiffening strategy. This experiment aimed to confirm in healthy young and older adults that performing a cognitive task while standing leads to improvements that are due to automaticity of sway by using sample entropy. Twenty-one young adults and twenty-five older adults were asked to stand on a force platform while performing a cognitive task. There were four cognitive tasks: simple reaction time, go/no-go reaction time, equation and occurrence of a digit in a number sequence. Results demonstrated decreased sway area and variability as well as increased sample entropy for both groups when performing a cognitive task. Results suggest that performing a concurrent cognitive task promotes the adoption of an automatic postural control in young and older adults as evidenced by an increased postural stability and postural sway complexity.

Continuous and difficult discrete cognitive tasks promote improved stability in older adults

Directing attention away from postural control and onto a cognitive task affords the emergence of automatic control processes. Perhaps the continuous withdrawal of attention from the postural task facilitates an automatization of posture as opposed to only intermittent withdrawal; however this is unknown in the aging population. Twenty older adults (69.9±3.5years) stood with feet together on a force platform for 60s while performing randomly assigned discrete and continuous cognitive tasks. Participants were instructed to stand comfortably with their arms by their sides while verbally responding to the auditory stimuli as fast as possible during the discrete tasks, or mentally performing the continuous cognitive tasks. Participants also performed single-task standing. Results demonstrate significant reductions in sway amplitude and sway variability for the difficult discrete task as well as the continuous tasks relative to single-task standing. The continuous cognitive tasks also prompted greater frequency of sway in the anterior-posterior direction compared to single-standing and discrete tasks, and greater velocity in both directions compared to single-task standing, which could suggest ankle stiffening. No differences in the simple discrete condition were shown compared to single-task standing, perhaps due to the simplicity of the task. Therefore, we propose that the level of difficulty of the task, the specific neuropsychological process engaged during the cognitive task, and the type of task (discrete vs. continuous) influence postural control in older adults. Dual-tasking is a common activity of daily living; this work provides insight into the age-related changes in postural stability and attention demand.

The effects of attentional focus and cognitive tasks on postural sway may be the result of automaticity

Research reveals improvements in postural control when focus is placed on movement effects rather than movement production, and further improvements during the performance of a concurrent cognitive task. It has yet to be determined if these changes are due to the use of an ankle stiffening strategy or to the use of more automatic postural control processes. The objectives of the present study were to replicate the effect of attentional focus and cognitive tasks on postural control and to test that no change occurs in lower leg muscle activity in these conditions. Twenty five healthy young adults (20.7±2.76years, 10 male) were asked to stand still while performing various tasks: baseline standing, internally focusing on minimizing movement of the ankles, externally focusing on minimizing movement of an apparatus placed on their ankle joint, and two cognitive tasks consisting of counting and simultaneously summing one or two single digits in a series of three-digit numbers. Compared to baseline and internal focus, sway decreased in external focus conditions and decreased further in cognitive task conditions. Furthermore, sway velocity increased in cognitive task conditions and sway frequency increased in the medial-lateral direction in the more difficult cognitive task. Finally, no effect of condition was found on muscle activity around the ankle joint. Collectively, the findings lend support to the hypothesis that changes in postural control were the result of an automatic type of postural control rather than due to stiffening occurring at the ankle joint.

Design and Validation of a Low-Cost Portable Device to Quantify Postural Stability

Measurement of the displacement of the center-of-pressure (COP) is an important tool used in biomechanics to assess postural stability and human balance. The goal of this research was to design and validate a low-cost portable device that can offer a quick indication of the state of postural stability and human balance related conditions. Approximate entropy (ApEn) values reflecting the amount of irregularity hiding in COP oscillations were used to calculate the index. The prototype adopted a portable design using the measurements of the load cells located at the four corners of a low-cost force platform. The test subject was asked to stand on the device in a quiet, normal, upright stance for 30 s with eyes open and subsequently for 30 s with eyes closed. Based on the COP displacement signals, the ApEn values were calculated. The results indicated that the prototype device was capable of capturing the increase in regularity of postural control in the visual-deprivation conditions. It was also able to decipher the subtle postural control differences along anterior–posterior and medial–lateral directions. The data analysis demonstrated that the prototype would enable the quantification of postural stability and thus provide a low-cost portable device to assess many conditions related to postural stability and human balance such as aging and pathologies.

Effect of Biomechanical Constraints on Neural Control of Head Stability in Children With Moderate to Severe Cerebral Palsy

BACKGROUND

External support has been viewed as an important biomechanical constraint for children with deficits in postural control. Nonlinear analysis of head stability may be helpful to confirm benefits of interaction between external trunk support and level of trunk control.

OBJECTIVE

The purpose of this study was to compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control.

DESIGN

This was a quasi-experimental repeated-measures study.

METHODS

Data from 15 children (4-16 years of age) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8 [4 boys, 4 girls]) or severe (GMFCS V; n=7 [4 boys, 3 girls]) cerebral palsy (CP) were compared with previous longitudinal data from infants with typical development (TD) (3-9 months of age). Kinematic data were used to document head sway with external support at 4 levels (axillae, midrib, waist, and hip). Complexity, predictability, and active degrees of freedom for both anterior-posterior and medial-lateral directions were assessed.

RESULTS

Irrespective of level of support, CP groups had lower complexity, increased predictability, and greater degrees of freedom. The effect of support differed based on the child's segmental level of control. The GMFCS V and youngest TD groups demonstrated better head control, with increased complexity and decreased predictability, with higher levels of support. The GMFCS IV group had the opposite effect, showing decreased predictability and increased complexity and degrees of freedom with lower levels of support.

LIMITATIONS

Infants with typical development and children with CP were compared based on similar segmental levels of trunk control; however, it is acknowledged that the groups differed for age, cognitive level, and motor experience.

CONCLUSIONS

The effect of external support varied depending on the child's level of control and diagnostic status. Children with GMFCS V and young infants with TD had better outcomes with external support, but external support was not enough to completely correct for the influence of CP. Children with GMFCS IV performed worse, with increased predictability and decreased complexity, when support was at the axillae or midribs, suggesting that too much support can interfere with postural sway quality.

The Effect of Distractive Function on Volitional Preemptive Abdominal Contraction During a Loaded Forward Reach in Normal Subjects

BACKGROUND

Volitional preemptive abdominal contraction (VPAC) is used to protect the spine and prevent injury. No published studies to data have examined the effect of distraction on VPAC use during function.

OBJECTIVE

To examine the effect of an auditory distraction ("Stroop task") on healthy subjects' ability to sustain VPAC by use of the abdominal drawing-in maneuver during loaded forward reach.

DESIGN

Within-subjects, repeated-measure cohort design.

SETTING

Clinical laboratory setting.

PARTICIPANTS

Convenience sample of 42 healthy individuals (ages 20-57 years).

METHODS

Transversus abdominis (TrA) thickness was measured with M-mode ultrasound imaging. Each subject performed Stroop versus no Stroop during 4 conditions: (1) without VPAC, quiet standing; (2) with VPAC, quiet standing; (3) without VPAC, forward reach; and (4) with VPAC, forward reach. An investigator blinded to the conditions measured the first 10 subjects to establish intratester reliability of probe/transducer placement and TrA measurement.

DATA REDUCTION

TrA thickness (mm) change represented VPAC performance. A single investigator measured onscreen TrA thickness twice at each second from second-6 through -10 on a recorded ultrasound imaging sequence.

RESULTS

A 2 (Stroop) × 4 (Activity) repeated-measures analysis of variance found no significant Stroop × Activity interaction [F(3, 93) = 0.345, P = .793] and no main effect for Stroop [F (1,31) = 1.324, P = .259] but found a significant main effect for activity [F (3,93) = 17.729, P < .001]. Tukey post-hoc pairwise comparisons demonstrated significant differences between VPAC versus no-VPAC conditions, except between quiet standing/yes-VPAC and loaded forward reach/no-VPAC conditions (P = .051). The interclass correlation coefficient (3,2) for probe/transducer placement reliability was 0.87, 0.91, 0.92, and 0.93 for conditions 1-4, respectively. The interclass correlation coefficient (3,2) for TrA measurement reliability was 0.96, 0.99, 0.99, and 0.99 for conditions 1-4, respectively.

CONCLUSION

A distracting executive function (Stroop task) did not produce a significant negative impact on normal individuals' ability to sustain a VPAC during quiet standing or loaded forward reach activities.

LEVEL OF EVIDENCE

II.

Virtual reality applications in assessing the effect of anxiety on sensorimotor integration in human postural control

Falls are a leading cause of injury and mortality among adults over the age of 65 years. Given the strong relation between fear of falling and fall risk, identification of the mechanisms that underlie anxiety-related changes in postural control may pave the way to the development of novel therapeutic strategies aimed at reducing fall risk in older adults. First, we review potential mechanisms underlying anxiety-mediated changes in postural control in older adults with and without neurological conditions. We then present a system that allows for the simultaneous recording of neural, physiological, and behavioral data in an immersive virtual reality (VR) environment while implementing sensory and mechanical perturbations to evaluate alterations in sensorimotor integration under conditions with high postural threat. We also discuss applications of VR in minimizing falls in older adults and potential future studies.