Explicit and implicit knowledge of environment states induce adaptation in postural control

The impact of external and internal focus of attention on visual dependence and EEG alpha oscillations during postural control

Background

The ability to maintain upright posture requires successful integration of multiple sensory inputs (visual, vestibular, and somatosensory). When one or more sensory systems become unreliable, the postural control system must “down-weight” (or reduce the influence of) those senses and rely on other senses to maintain postural stability. As individuals age, their ability to successfully reweight sensory inputs diminishes, leading to increased fall risk. The present study investigates whether manipulating attentional focus can improve the ability to prioritize different sensory inputs for postural control.

Methods

Forty-two healthy adults stood on a balance board while wearing a virtual reality (VR) head-mounted display. The VR environment created a multisensory conflict amongst the different sensory signals as participants were tasked with maintaining postural stability on the balance board. Postural sway and scalp electroencephalography (EEG) were measured to assess visual weighting and cortical activity changes. Participants were randomized into groups that received different instructions on where to focus their attention during the balance task.

Results

Following the instructions to direct attention toward the movement of the board (external focus group) was associated with lower visual weighting and better balance performance than when not given any instructions on attentional focus (control group). Following the instructions to direct attention towards movement of the feet (internal focus group) did not lead to any changes in visual weighting or balance performance. Both external and internal focus groups exhibited increased EEG alpha power (8–13 Hz) activity over the occipital cortex as compared to the control group.

Conclusions

Current results suggest that directing one’s attention externally, away from one’s body, may optimize sensory integration for postural control when visual inputs are incongruent with somatosensory and vestibular inputs. Current findings may be helpful for clinicians and researchers in developing strategies to improve sensorimotor mechanisms for balance.

Haptic Information Improvement on Postural Sway is Information-Dependent But Not Influenced by Cognitive Task

Young adults reduce their sway in both light touch (LT) and anchor systems (AS), however, the cognitive involvement in these tasks is unknown. This study investigated postural control in young adults standing upright using either LT or AS, concomitantly with a cognitive task (counting). Nine adults (26 ± 7.4 years) stood in the upright tandem stance with eyes closed, with/without LT, AS (force <2 N), and a cognitive task. The mean sway amplitude of the trunk, right wrist, and shoulder ellipse area, as well as the mean force during LT and AS were obtained. The cognitive task did not influence the magnitude of trunk sway or the mean force in the LT and AS conditions. The trunk sway magnitude was reduced in the AS and even further in LT. Wrist and shoulder variability was larger in the AS than in the LT. Based on these results, we conclude that enhanced sensory cues provided by LT and AS reduce trunk sway with little or no attentional demands.

Saccadic eye movement performance reduces visual manipulation influence and center of pressure displacements in older fallers

This study examined changes in postural control and gaze performance of faller and non-faller older adults under conditions of visual tasks and optical flow manipulations. Fifteen older non-fallers (69.8 years, ± 3.2) and fifteen older fallers (71.1 years, ± 6.4) stood on a force platform inside a moving room wearing an eye tracker. Four tasks were performed: gaze fixation; predictable saccades; unpredictable saccades; and free-viewing. The stimuli appeared at a frequency of 1.1 Hz during conditions of predictable and unpredictable saccades. Sixteen trials were divided into two blocks. In the first block, the room remained stationary. In the second block, the room oscillated, without the participant's awareness, with a 0.6 cm amplitude and 0.2 Hz frequency. Results showed postural sway attenuation in older fallers during the saccadic tasks compared to gaze fixation and free-viewing tasks, in both stationary and moving room conditions. Both groups showed increased center of pressure (CoP) magnitude during the moving room condition and CoP displacements strongly coupled to the room's movement. The influence of the moving room on the postural sway was reduced during the saccadic tasks for both older groups. Older fallers exhibited higher variability compared to older non-fallers. Gaze behavior differences between groups were dependent on the goals of the visual tasks. Therefore, CoP displacements of older adults are reduced during saccadic tasks regardless of their falling history. However, postural and gaze performance of older fallers suggests increased deterioration of postural and oculomotor control which may be used as a predictor of fall risk.

Cognitive processes and a centre-of-pressure error-based moving light-touch biofeedback

Lightly touching an earth-fixed external surface with the forefinger provides somatosensory information that reduces the center of pressure (CoP) oscillations. If this surface were to move slowly, the central nervous system (CNS) would misinterpret its movement as body self-motion, and involuntary compensatory sway responses would appear, resulting in a significant coupling between finger and CoP motions. We designed a forefinger moving light-touch biofeedback based on this finding, which controls the surface velocity to drive the CoP towards a target position. Here, we investigate this biofeedback resistance to cognitive processes. In addition to a baseline, the experimental protocol includes four main conditions. In the first, participants were utterly naive about the feedback. Then, they received additional reliable sensory information. The third condition ensured their full awareness of the external nature of the surface motion. Finally, the experimenter notified them that the external motion drives their balance and asked them to reject its influence. Our investigation shows that despite the robustness of the proposed biofeedback, light-touch remains penetrable by cognitive processes. For participants to dramatically reduce the existing coupling between the finger and CoP motions, they should be aware of the external motion, how it impacts sway, and actively reject its influence. The main implication of our findings is that light-touch exhibits the same cognitive flexibility as vision when artificially stimulated. This could be interpreted as a defense mechanism to re-weight these two sensory inputs in a moving environment.

Dyslexic children need more robust information to resolve conflicting sensory situations

The study involved investigating dyslexic children's postural control responses when visual and somatosensory cues were separately manipulated. Twenty dyslexic and 19 nondyslexic children performed a trial by standing upright inside a moving room and another by lightly touching a moving bar. Both trials lasted 240 s with the following three different stimulus characteristics: low (pretransition), high (transition), and low amplitude (posttransition). Body sway magnitude and the relationship between the movement of the room/bar surface and body sway were examined. When compared to nondyslexic children, dyslexic children oscillated with higher magnitude in the transition and posttransition under visual and somatosensory manipulation; their sway was more influenced by visual manipulation in the transition and posttransition, and they used higher applied force levels in the somatosensory modality in all conditions. The results suggest that dyslexic children could not efficiently reweight visual cues when compared to nondyslexic children. The same was not observed in the somatosensory cues when dyslexic children reduced the influence of the somatosensory stimulus. The proper use of somatosensory information was related to stronger acquired cues and higher applied forces as observed for dyslexic children. Dyslexic children experience difficulties in dynamically reweighting sensory cues although these types of difficulties are overcome when more informative sensory cues are provided.

From One to Two: Can Visual Feedback Improve the Light Touch Effects on Postural Sway?

The postural control is improved by implicit somatosensory information from lightly touching a rigid bar or explicit visual information about the postural sway. Whether these two additional sources provided at the same time further reduce the postural sway is still unknown. Participants stood on a force plate as quiet as possible lightly touching the bar while received or not visual feedback of the center of pressure position on a monitor screen. Postural sway reduced similarly with the light touch regardless of the additional visual feedback. The findings suggested that providing explicit visual feedback of the center of pressure does not increase the light touch effects on the postural sway. The importance of the implicit somatosensory information on postural control is discussed.

Parkinson's disease does not alter automatic visual-motor coupling in postural control

This study examined the coupling between visual information and body sway in patients with Parkinson's disease (PD) compared with healthy controls. Postural control performance was compared between 14 patients with PD (age: 69.6 ± 8.8 years - stages 1-3 of the Hoehn and Yahr scale) and 14 healthy control participants (age: 68.6 ± 3.0 years). Participants stood upright in a moving room that remained motionless or continuously oscillated in the anterior-posterior direction. Ten trials were performed in the following conditions: no movement of the room (1 trial) and with the room moving at frequencies of 0.1, 0.17, and 0.5 Hz (3 trials each frequency). Body sway and moving room displacement were recorded. The results indicated that patients with PD displayed larger body sway magnitude in the stationary room condition. Body sway of patients with PD was induced by visual manipulation in all three visual stimulus frequencies, but body sway of patients with PD was less coherent compared to that of the control participants. However, no difference was observed in the visual-body sway coupling structure. These results indicate that patients with PD can unconsciously couple body sway to visual information in order to control postural sway in a similar manner to healthy participants with intact visual-motor coupling for posture control. However, this coupling is marked by greater variability, indicating that people with PD have a motor system with greater inherent noise leading to a more varied behavior.

Quality of Visual Cue Affects Visual Reweighting in Quiet Standing

Sensory reweighting is a characteristic of postural control functioning adopted to accommodate environmental changes. The use of mono or binocular cues induces visual reduction/increment of moving room influences on postural sway, suggesting a visual reweighting due to the quality of available sensory cues. Because in our previous study visual conditions were set before each trial, participants could adjust the weight of the different sensory systems in an anticipatory manner based upon the reduction in quality of the visual information. Nevertheless, in daily situations this adjustment is a dynamical process and occurs during ongoing movement. The purpose of this study was to examine the effect of visual transitions in the coupling between visual information and body sway in two different distances from the front wall of a moving room. Eleven young adults stood upright inside of a moving room in two distances (75 and 150 cm) wearing a liquid crystal lenses goggles, which allow individual lenses transition from opaque to transparent and vice-versa. Participants stood still during five minutes for each trial and the lenses status changed every one minute (no vision to binocular vision, no vision to monocular vision, binocular vision to monocular vision, and vice-versa). Results showed that farther distance and monocular vision reduced the effect of visual manipulation on postural sway. The effect of visual transition was condition dependent, with a stronger effect when transitions involved binocular vision than monocular vision. Based upon these results, we conclude that the increased distance from the front wall of the room reduced the effect of visual manipulation on postural sway and that sensory reweighting is stimulus quality dependent, with binocular vision producing a much stronger down/up-weighting than monocular vision.

Adaptation of sensorimotor coupling in postural control is impaired by sleep deprivation

The purpose of the study was to investigate the effects of sleep deprivation (SD) in adaptation of the coupling between visual information and body sway in young adults’ postural control due to changes in optic flow characteristics. Fifteen young adults were kept awake for approximately 25 hours and formed the SD group, while fifteen adults who slept normally the night before the experiment participated as part of the control group. All participants stood as still as possible in a moving room before and after being exposed to one trial with higher amplitude and velocity of room movement. Postural performance and the coupling between visual information, provided by a moving room, and body sway were examined. Results showed that after an abrupt change in visual cues, larger amplitude, and higher velocity of the room, the influence of room motion on body sway was decreased in both groups. However, such a decrease was less pronounced in sleep deprived as compared to control subjects. Sleep deprived adults were able to adapt motor responses to the environmental change provided by the increase in room motion amplitude. Nevertheless, they were not as efficient as control subjects in doing so, which demonstrates that SD impairs the ability to adapt sensorimotor coupling while controlling posture when a perturbation occurs.