Modulating active stiffness affects head stabilizing strategies in young and elderly adults during trunk rotations in the vertical plane

The role of neck muscle co-contraction and postural changes in head kinematics after safe head impacts: Investigation of head/neck injury reduction

Concerns surrounding concussions from impacts to the head necessitate research to generate new knowledge about ways to prevent them and reduce risk. In this paper, we report the relative temporal characteristics of the head resulting from neck muscle co-contraction and postural changes following a sudden force applied to the head in four different directions. In the two "prepared" conditions (i.e., co-contraction and postural), participants experienced impulsive forces to the head after hearing a warning. The warning given for the postural condition informed both the direction and timing of the impulsive force. Participants responded to the postural warning by altering their head posture, whereas in the co-contraction warning, the force direction was unknown to them, and they were asked to isometrically co-contract their neck muscles after the warning. Peak angular velocity reduced by 29% in sagittal extension, 18% in sagittal flexion, and 23% in coronal lateral flexion in prepared vs. unwarned conditions. Peak linear acceleration was attenuated by 15% in sagittal extension, 8% in sagittal flexion, and 18% in coronal lateral flexion in prepared vs. unwarned conditions. Changes in peak angular acceleration were not uniform. We also measured a significant delay in the peak angular velocity (22 vs. 44.8 ms) and peak angular acceleration (7 vs. 20 ms) after peak linear acceleration in prepared compared to unwarned conditions. An increase in muscle activation significantly reduced the peak angular velocity and linear acceleration. Gross head movement was significantly decreased with preparation. These findings suggest that a warning prior to impact can reduce head kinematics associated with injury.

Dynamic head-neck stabilization and modulation with perturbation bandwidth investigated using a multisegment neuromuscular model

The human head-neck system requires continuous stabilization in the presence of gravity and trunk motion. We investigated contributions of the vestibulocollic reflex (VCR), the cervicocollic reflex (CCR), and neck muscle co-contraction to head-in-space and head-on-trunk stabilization, and investigated modulation of the stabilization strategy with the frequency content of trunk perturbations and the presence of visual feedback. We developed a multisegment cervical spine model where reflex gains (VCR and CCR) and neck muscle co-contraction were estimated by fitting the model to the response of young healthy subjects, seated and exposed to anterior-posterior trunk motion, with frequency content from 0.3 up to 1, 2, 4 and 8Hz, with and without visual feedback. The VCR contributed to head-in-space stabilization with a strong reduction of head rotation (<8Hz) and a moderate reduction of head translation (>1Hz). The CCR contributed to head-on-trunk stabilization with a reduction of head rotation and head translation relative to the trunk (<2Hz). The CCR also proved essential to stabilize the individual intervertebral joints and prevent neck buckling. Co-contraction was estimated to be of minor relevance. Control strategies employed during low bandwidth perturbations most effectively reduced head rotation and head relative displacement up to 3Hz while control strategies employed during high bandwidth perturbations reduced head global translation between 1 and 4Hz. This indicates a shift from minimizing head-on-trunk rotation and translation during low bandwidth perturbations to minimizing head-in-space translation during high bandwidth perturbations. Presence of visual feedback had limited effects suggesting increased usage of vestibular feedback.

Head and Trunk Control While Walking in Older Adults with Diabetes: Effects of Balance Confidence

Investigations of gait in older adults with diabetes mellitus (DM) have been primarily focused on lower limb biomechanical parameters. Yet, the upper body accounts for two thirds of the body's mass, and head and trunk control are critical for balance. The authors examined head and trunk control during self-selected comfortable, fast, and dual-task walking and the relationship between balance confidence and potential head-trunk stiffening strategies in older adults with DM without diagnosed diabetic peripheral neuropathy (DPN). Twelve older adults with DM without diagnosed DPN (DM group) and 12 without DM (no-DM group) were recruited. Walking speed, peak-to-peak head and trunk roll displacement, head and trunk roll velocity, and head-trunk correlation were measured while walking at a self-selected comfortable or fastest possible speed with or without a secondary cognitive task. The Activities-specific Balance Confidence scale measured balance confidence. Subtle group differences in axial segmental control (lower trunk roll velocity; higher head-trunk correlation) were apparent in older adults with DM even in the absence of DPN. Balance confidence was 19% lower in the DM group than in the no-DM group, and partially explained (34%) the group difference in head-trunk stiffening. These results emphasize the need for proactive monitoring of postural control and balance confidence before the onset of DPN.

Dynamic head-neck stabilization in cervical dystonia

BACKGROUND

Effective sensorimotor integration is essential to modulate (adapt) neck stabilization strategies in response to varying tasks and disturbances. This study evaluates the hypothesis that relative to healthy controls cervical dystonia patients have an impaired ability to modulate afferent feedback for neck stabilization with changes in the frequency content of mechanical perturbations.

METHODS

We applied anterior-posterior displacement perturbations (110s) on the torso of seated subjects, while recording head-neck kinematics and muscular activity. We compared low bandwidth (0.2-1.2Hz) and high bandwidth (0.2-8Hz) perturbations where our previous research showed a profound modulation of stabilization strategies in healthy subjects. Cervical dystonia patients and age matched controls performed two tasks: (1) maintain head forward posture and (2) allow dystonia to dictate head posture.

FINDINGS

Patients and controls demonstrated similar kinematic and muscular responses. Patient modulation was similar to that of healthy controls (P>0.05); neck stiffness and afferent feedback decreased with high bandwidth perturbations. During the head forward task patients had an increased neck stiffness relative to controls (P<0.05), due to increased afferent feedback.

INTERPRETATION

The unaffected modulation of head-neck stabilization (both kinematic and muscular) in patients with cervical dystonia does not support the hypothesis of impaired afferent feedback modulation for neck stabilization.

Vestibular and cerebellar contribution to gaze optimality

Patients with chronic bilateral vestibular loss have large gaze variability and experience disturbing oscillopsia, which impacts physical and social functioning, and quality of life. Gaze variability and oscillopsia in these patients are attributed to a deficient vestibulo-ocular reflex, i.e. impaired online feedback motor control. Here, we assessed whether the lack of vestibular input also affects feed-forward motor learning, i.e. the ability to choose optimal movement parameters that minimize variability during active movements such as combined eye-head gaze shifts. A failure to learn from practice and reshape feed-forward motor commands in response to sensory error signals to achieve appropriate movements has been proposed to explain dysmetric gaze shifts in patients with cerebellar ataxia. We, therefore, assessed the differential roles of both sensory vestibular information and the cerebellum in choosing optimal movement kinematics. We have previously shown that, in the course of several gaze shifts, healthy subjects adjust the motor command to minimize endpoint variability also when movements are experimentally altered by an increase in the head moment of inertia. Here, we increased the head inertia in five patients with chronic complete bilateral vestibular loss (aged 45.4±7.1 years, mean±standard deviation), nine patients with cerebellar ataxia (aged 56.7±12.6 years), and 10 healthy control subjects (aged 39.7±6.3 years) while they performed large (75° and 80°) horizontal gaze shifts towards briefly flashed targets in darkness and, using our previous optimal control model, compared their gaze shift parameters to the expected optimal movements with increased head inertia. Patients with chronic bilateral vestibular loss failed to update any of the gaze shift parameters to the new optimum with increased head inertia. Consequently, they displayed highly variable, suboptimal gaze shifts. Patients with cerebellar ataxia updated some movement parameters to serve the minimum variance optimality principle but inaccurately undershot the target leading to an average gaze error of 11.4±2.0°. Thus, vestibulopathy leads to gaze variability not only as a result of deficient online gaze control but also a failure in motor learning because of missing error signals. Patients with cerebellar ataxia in our setting can learn from practice-similar to recent findings in reaching movements-and reshape feed-forward motor commands to decrease variability. However, they compromise optimality with inaccurately short movements. The importance of vestibular information for motor learning implies that patients with incomplete bilateral vestibulopathy, and patients with cerebellar ataxia, should be advised to actively move their head whenever appropriate. This way, sensory error signals can be used to shape the motor command and optimize gaze shifts trial-by-trial.

Coordination of the head with respect to the trunk, pelvis, and lower leg during quiet stance after vestibular loss

This study examined the relationship between head and trunk sway and between pelvis and leg sway during quiet stance in subjects with long-standing bilateral peripheral vestibular loss (BVLs) comparing these relationships to those of age-matched healthy controls (HCs). All subjects performed three different stance tasks: standing quietly on a firm or foam support surface, with eyes closed (ECF or eyes closed on normal) and on foam with eyes open. Data were recorded with four pairs of body-worn gyroscopes to measure roll and pitch angular velocities at the head, upper trunk, pelvis and lower-leg. These velocities were spectrally analysed and integrated for angle correlation analysis in three frequency bands: below 0.7Hz (low pass, LP), above 3 Hz (high pass, HP) and in between (band pass, BP). For both groups head motion was greater than trunk and pelvis motion except for BVL subjects (BVLs) under ECF conditions. BVLs had greater motion than HCs at all measurement locations for ECF conditions. Angle correlation analysis indicated that the head was almost "locked" to the trunk for BVLs over the LP and BP frequency bands. Head movements for both groups were relatively independent of the trunk in the HP band. Power spectral density ratios, and transfer functions showed a similar result - head relative to trunk movements were less up to 3 Hz in all tests for BVLs. The resonant frequency of head-on-trunk motion was shifted to a higher frequency for BVLs: from 3.2 to 4.3 Hz in pitch, 4.6 to 5.4 Hz in roll. Both groups show greater lower-leg than pelvis motion. These data indicate that during quiet stance BVLs change the characteristics of their head on shoulder motion, reducing relative motion of the head below 3 Hz and increasing head resonant frequency. Presumably these changes are accomplished with increased use of proprioceptive neck reflexes.

Vestibular control of the head: possible functions of the vestibulocollic reflex

Here, we review the angular vestibulocollic reflex (VCR) focusing on its function during unexpected and voluntary head movements. Theoretically, the VCR could (1) stabilize the head in space during body movements and/or (2) dampen head oscillations that could occur as a result of the head's underdamped mechanics. The reflex appears unaffected when the simplest, trisynaptic VCR pathways are severed. The VCR's efficacy varies across species; in humans and monkeys, head stabilization is ineffective during low-frequency body movements in the yaw plan. While the appearance of head oscillations after the attenuation of semicircular canal function suggests a role in damping, this interpretation is complicated by defects in the vestibular input to other descending motor pathways such as gaze premotor circuits. Since the VCR should oppose head movements, it has been proposed that the reflex is suppressed during voluntary head motion. Consistent with this idea, vestibular-only (VO) neurons, which are possible vestibulocollic neurons, respond vigorously to passive, but not active, head rotations. Although VO neurons project to the spinal cord, their contribution to the VCR remains to be established. VCR cancelation during active head movements could be accomplished by an efference copy signal negating afferent activity related to active motion. Oscillations occurring during active motion could be eliminated by some combination of reflex actions and voluntary motor commands that take into account the head's biomechanics. A direct demonstration of the status of the VCR during active head movements is required to clarify the function of the reflex.

State-dependent sensorimotor processing: gaze and posture stability during simulated flight in birds

Vestibular responses play an important role in maintaining gaze and posture stability during rotational motion. Previous studies suggest that these responses are state dependent, their expression varying with the environmental and locomotor conditions of the animal. In this study, we simulated an ethologically relevant state in the laboratory to study state-dependent vestibular responses in birds. We used frontal airflow to simulate gliding flight and measured pigeons' eye, head, and tail responses to rotational motion in darkness, under both head-fixed and head-free conditions. We show that both eye and head response gains are significantly higher during flight, thus enhancing gaze and head-in-space stability. We also characterize state-specific tail responses to pitch and roll rotation that would help to maintain body-in-space orientation during flight. These results demonstrate that vestibular sensorimotor processing is not fixed but depends instead on the animal's behavioral state.

Head movements produced during whole body rotations and their sensitivity to changes in head inertia in squirrel monkeys

The head's inertia produces forces on the neck when the body moves. One collective function of the vestibulocollic and cervicocollic reflexes (VCR and CCR) is thought to be to stabilize the head with respect to the trunk during whole body movements. Little is known as to whether their head-movement kinematics produced by squirrel monkeys during whole body rotations are similar to those of cats and humans. Prior experiments with cats and human subjects have shown that yaw head-movement kinematics are unaffected by changes in the head's inertia when the whole body is rotated. These observations have led to the hypothesis that the combined actions of the VCR and CCR accommodate for changes in the head's inertia. To test this hypothesis in squirrel monkeys, it was imperative to first characterize the behavior of head movements produced during whole body rotation and then investigate their sensitivity to changes in the head's inertia. Our behavioral studies show that squirrel monkeys produce only small head movements with respect to the trunk during whole body rotations over a wide range of stimulus frequencies and velocities (0.5-4.0 Hz; 0-100 degrees /s). Similar head movements were produced when only small additional changes in the head's inertia occurred. Electromyographic recordings from the splenius muscle revealed that an active process was utilized such that increases in muscle activation occurred when the inertia of the head was increased. These results are consistent with prior cat and human studies, suggesting that squirrel monkeys have a similar horizontal VCR and CCR.

Age-related differences during a gaze reorientation task while standing or walking on a treadmill

Falls among adults over the age of 65 years have become a growing concern. Two factors related to high incidence of falls in this group of adults are decreased head stability and impaired balance. Older adults' level of control of head stability or balance is unknown when they must reorient their gaze. In the current study, ten older adults (69 +/- 3.27 years) performed a gaze reorienting task while standing or walking on a treadmill. The task was the same as that used on young adults by Cinelli et al. (2007). The results show that older adults use a different strategy than young adults when reorienting gaze. Shoulder and hip rotations occurred synchronously when standing and were more variable when walking on a treadmill. As well, there was a larger difference between the onset of eye movements and body segment movement in the older adults. These differences can be accounted for by decreases in physiological subsystems. The visual presence of a visual target helped the older adults stabilize their heads-in-space by incorporating information from more than one sensory system.

Psychophysiological correlates of the inter-individual variability of head movement control in seated humans

We recently conducted experiments where 24 seated participants were subjected (with eyes closed) to small amplitude, high-jerk impulses of linear acceleration. Responses were distributed as a continuum between two extremes. The "stiff" participants showed little movement of the head relative to the trunk, whereas the "floppy" participants showed a large head rotation in the direction opposite the sled movement. We hypothesized that the stiff behavior resulted from the spontaneous use of an imagined visual frame of reference and undertook this larger-scale study to test that idea. The distribution along the "stiff-floppy" continuum was compared with the scores on psychophysiological tests measuring vividness of imagery, visual field-dependence and motion sickness susceptibility. Multivariate regression analysis revealed that the "stiffness" of individuals was loosely, but significantly related to the vividness of their imagery. However, "stiffness" was not linked to visual field-dependence or motion sickness susceptibility. Even if it explains only 20% of the variance of the data, the increase of "stiffness" with vividness of imagery fits our hypothesis. With eyes closed, stiff people may use imagined external visual cues to stabilize their head and trunk. Floppy people, who are poorer imagers, may rely more on "egocentric", proprioceptive and vestibular inputs.

The role of the neck and trunk in facilitating head stability during walking

An apparent goal of the human postural system is to maintain head stability during walking. Although much is known about sensory-motor stabilising mechanisms associated with the head and neck, less is known about how the postural system attenuates motion between the trunk and neck segments in order to regulate head motion. Therefore the purpose of this study was to determine the role that the neck and the trunk play in stabilising the head at a range of walking speeds. Eight healthy male subjects (age: 23+/-4 years) performed self-selected slow, preferred, and fast walking speed trials along a 30 m walkway. Four custom-designed wireless triaxial accelerometers were attached to the head, upper trunk, lower trunk, and shank of each subject to measure vertical (VT), anterior-posterior (AP), and mediolateral (ML) accelerations. Acceleration data were examined in each direction using RMS, power spectral, harmonic, and regularity measures. Signal regularity was increased from the lower to upper trunk for all walking speeds and directions with the exception of the slow speed in the AP direction. Evidence from analysis of power spectral and amplitude characteristics of acceleration signals was suggestive that accelerations are also attenuated from the lower to upper trunk by dynamics of the intervening trunk segment. Differences in selected power spectral and amplitude characteristics between the accelerations of the upper trunk and head due to the intervening neck segment were only detected in the AP direction at preferred and fast walking speeds. Overall the findings of the present study suggest that the trunk segment plays a critical role in regulating gait-related oscillations in all directions. Only accelerations in the direction of travel at preferred and fast speeds required additional control from the neck segment in order to enhance head stability during walking.

Head stabilization strategies in the sagittal plane during locomotor tasks

BACKGROUND AND PURPOSE

Head stability is the dynamic process of maintaining an equilibrium position of the head-in-space. Individuals with vestibular deficits restrict head movements during dynamic activities in an effort to adapt to vestibular loss. However, this strategy does not provide them with a successful means for adaptation during dynamic tasks where head movements are required. Therefore, identification of successful head stabilization strategies is the first step towards improving the rehabilitation of these patients. The purpose of the present study was twofold: to characterize the sagittal plane head stabilization response during walking; and to identify successful head stabilization strategies during normal walking and during a walking task that challenged head stability.

METHOD

The study used a repeated-measures design. Eight healthy volunteers walked normally (normal condition) and walked whilst swinging their arms at twice the natural frequency (frequency condition). Head and trunk angular velocities were measured to determine head velocity magnitudes, and head-on-trunk, with respect to trunk gains and phases across the frequency spectrum of walking.

RESULTS

The frequency condition increased the challenge to head stabilization and produced phases indicative of increased head stability (p < 0.05). Post hoc analyses revealed that the shift in phase occurred at higher frequencies (> 8 Hz) (p < 0.05). Increased head velocity magnitudes (p < 0.05) accompanied by decreased variability (p < 0.05) were also found at higher frequencies for the frequency condition.

CONCLUSIONS

The results were indicative of a tightly controlled movement strategy that ensured head stabilization under conditions where head stability was challenged. This strategy was characterized by head-on-trunk movement that was equal and opposite to trunk motion.

Identification of the head-neck complex in response to trunk horizontal vibration

A method is proposed for identifying the head-neck complex (HNC) in the seated human body when it is exposed to the trunk horizontal (fore-and-aft) vibration. It is assumed that the HNC only has the anteroposterior (flexion/extension) motion in the sagittal plane. An electrohydraulic vibrator is used as a source of vibration. To generate the trunk horizontal vibration, the trunk of the seated subject is fixed to the seatback. The subjects are exposed to the random vibration at a magnitude of 1.60 ms(-2) rms (root-mean-square) for 50 s. The coherence and frequency response function are then obtained in the frequency range 0.5-3 Hz. The results show that the HNC behavior is quasilinear with a resonance frequency between 1 and 1.4 Hz. Accordingly, a two-dimensional single-inverted pendulum is considered as a model for the HNC. The frequency domain identification method is then used to estimate the unknown parameters, including the HNC viscoelastic and inertia parameters. The model is examined in a time domain using the random vibration. Good agreement is obtained between experimental and simulation results, indicating the reliability of the proposed method.

Improved ambulation and speech production in an adolescent post-traumatic brain injury through a therapeutic intervention to increase postural control

PURPOSE

This case study examined the effectiveness of a programme designed to improve anticipatory postural control in an adolescent over years 2 and 3 post-traumatic brain injury (TBI). It was hypothesized that her difficulty in walking and talking simultaneously was caused by excessive co-activation of extremity, trunk, and oral musculature during upright activities.

METHODS

The participant was treated weekly by physical and speech therapy. Treatment focussed on improving anticipatory postural control during gross motor activities in conjunction with oral-motor function.

RESULTS

Initially, the participant walked using a walker at a speed of 23 cm s(-1). Two years later, she could walk without a device at 53 cm s(-1). Initial laryngoscopic examination showed minimal movement of the velum or pharyngeal walls; full movement was present after treatment. The measure of intelligibility improved from no single word intelligible utterances to 85% intelligible utterances after 2 years.

DISCUSSION

The results suggest that less compensatory rigidification of oral musculature was needed to maintain an upright position against gravity as postural control improved.

CONCLUSION

An adolescent 1-year post-TBI was followed as she underwent additional rehabilitation focussed on improving anticipatory postural control. The functional goal of simultaneously talking while walking was achieved through this intervention.

Head-trunk coordination during linear anterior-posterior translations

The purpose of this study was to evaluate the relative contributions of inputs from the vestibular system and the trunk to head-trunk coordination. Twelve healthy adults and 6 adults with diminished bilateral labyrinthine input (LD) were seated with their trunk either fixed to the seat or free to move. Subjects received 10-cm, 445-cm/s(2) anterior-posterior ramps and 0.35- to 4.05-Hz sum-of-sines translations while performing a mental distraction task in the dark. Kinematics of the head and trunk were derived from an Optotrak motion analysis system and a linear accelerometer placed on the head. EMG signals were collected from neck and paraspinal muscles. Data were tested for significance with multivariate ANOVA (MANOVA) and Bonferroni post hoc analyses. Initial linear and angular head acceleration directions differed in healthy subjects when the trunk was fixed or free, but did not differ in LD subjects. Peak head angular accelerations were significantly greater with the trunk fixed than when free, and were greater in LD than in control subjects. EMG response latencies did not differ when the trunk was fixed or free. Low-frequency phase responses in the healthy subjects were close to 90 degrees and had a delayed descent as frequency increased, suggesting some neural compensation that was absent in the LD subjects. Results of this study revealed a strong initial reliance on system mechanics and on signals from segmental receptors. The vestibular system may act to damp later response components and to monitor the position of the head in space secondary to feedback from segmental proprioceptors rather than to generate the postural reactions.

Influence of vision on head stabilization strategies in older adults during walking

BACKGROUND

Maintaining balance during dynamic activities is essential for preventing falls in older adults. Head stabilization contributes to dynamic balance, especially during the functional task of walking. Head stability and the role of vision in this process have not been studied during walking in older adults.

METHODS

Seventeen older adults (76.2 +/- 6.9 years) and 20 young adults (26.0 +/- 3.4 years) walked with their eyes open (EO), with their eyes closed (EC), and with fixed gaze (FG). Participants performed three trials of each condition. Sagittal plane head and trunk angular velocities in space were obtained using an infrared camera system with passive reflective markers. Frequency analyses of head-on-trunk with respect to trunk gains and phases were examined for head-trunk movement strategies used for head stability. Average walking velocity, cadence, and peak head velocity were calculated for each condition.

RESULTS

Differences between age groups demonstrated that older adults decreased walking velocity in EO (p =.022). FG (p = .021), and EC (p = .022). and decreased cadence during EC (p = .007). Peak head velocity also decreased across conditions (p < .0001) for older adults. Movement patterns demonstrated increased head stability during EO. diminished head stability with EC, and improved head stability with FG as older adult patterns resembled those of young adults.

CONCLUSIONS

Increased stability of the lower extremity outcome measures for older adults was indicated by reductions in walking velocity and cadence. Concomitant increases in head stability were related to visual tasks. Increased stability may serve as a protective mechanism to prevent falls. Further, vision facilitates the head stabilization process for older adults to compensate for age-related decrements in other sensory systems subserving dynamic balance.

Variability in the control of head movements in seated humans: a link with whiplash injuries?

The aim of this study was to determine how context and on-line sensory information are combined to control posture in seated subjects submitted to high-jerk, passive linear accelerations. Subjects were seated with eyes closed on a servo-controlled linear sled. They were asked to relax and received brief accelerations either sideways or in the fore-aft direction. The stimuli had an abrupt onset, comparable to the jerk experienced during a minor car collision. Rotation and translation of the head and body were measured using an Optotrak system. In some of the subjects, surface electromyographic (EMG) responses of selected neck and/or back muscles were recorded simultaneously. For each subject, responses were highly stereotyped from the first trial, and showed little sign of habituation or sensitisation. Comparable results were obtained with sideways and fore-aft accelerations. During each impulse, the head lagged behind the trunk for several tens of milliseconds. The subjects' head movement responses were distributed as a continuum in between two extreme categories. The 'stiff' subjects showed little rotation or translation of the head relative to the trunk for the whole duration of the impulse. In contrast, the 'floppy' subjects showed a large roll or pitch of the head relative to the trunk in the direction opposite to the sled movement. This response appeared as an exaggerated 'inertial' response to the impulse. Surface EMG recordings showed that most of the stiff subjects were not contracting their superficial neck or back muscles. We think they relied on bilateral contractions of their deep, axial musculature to keep the head-neck ensemble in line with the trunk during the movement. About half of the floppy subjects displayed reflex activation of the neck muscles on the side opposite to the direction of acceleration, which occurred before or during the head movement and tended to exaggerate it. The other floppy subjects seemed to rely on only the passive biomechanical properties of their head-neck ensemble to compensate for the perturbation. In our study, proprioception was the sole source of sensory information as long as the head did not move. We therefore presume that the EMG responses and head movements we observed were mainly triggered by the activation of stretch receptors in the hips, trunk and/or neck. The visualisation of an imaginary reference in space during sideways impulses significantly reduced the head roll exhibited by floppy subjects. This suggests that the adoption by the central nervous system of an extrinsic, 'allocentric' frame of reference instead of an intrinsic, 'egocentric' one may be instrumental for the selection of the stiff strategy. The response of floppy subjects appeared to be maladaptive and likely to increase the risk of whiplash injury during motor vehicle accidents. Evolution of postural control may not have taken into account the implications of passive, high-acceleration perturbations affecting seated subjects.