The startle response during whiplash: a protective or harmful response?

The effect of reclined seatback angles on the motion of booster-seated children during lateral-oblique low-acceleration impacts

Belt-positioning boosters (BPB) may prevent submarining in novel seating configurations such as seats with reclined seatbacks. However, several knowledge gaps in the motion of reclined child occupants remain as previous reclined child studies only examined responses of a child anthropomorphic test device (ATD) and the PIPER finite element (FE) model in frontal impacts. The aim of this study is to investigate the effect of reclined seatback angles and two types of BPBs on the motion of child volunteer occupants in low-acceleration far-side lateral-oblique impacts. Six healthy children (3 males, 3 females, 6-8 years, seated height: 66±3.2 cm, weight: 25.2±3.2 kg) were seated on two types of low-back BPB (standard and lightweight) on a vehicle seat and restrained by a 3-point simulated-integrated seatbelt on a low-acceleration sled. The sled exposed the participants to a low-speed lateral-oblique (80° from frontal) pulse (2 g). Three seatback recline angles (25°, 45°, 60° from vertical) with two BPB (standard and lightweight) were tested. A 10-camera 3D-motion-capture system (Natural Point Inc.) was used to capture peak lateral head and trunk displacements and forward knee-head distance. Three seat-belt load cells (Denton ATD Inc) captured peak seatbelt loads. Electromyography (EMG, Delsys Inc) recorded muscle activation. Repeated Measure 2-way ANOVAs were performed to evaluate the effect of seatback recline angle and BPB on kinematics. Tukey's post-hoc test for pairwise comparisons was used. P-level was set to 0.05. Peak lateral head and trunk displacement decreased with the increasing seatback recline angle (p < 0.005, p < 0.001, respectively). Lateral peak head displacement was greater in the 25° compared to the 60° condition (p < 0.002) and in the 45° condition compared to the 60° condition (p < 0.04). Lateral peak trunk displacement was greater in the 25° condition than the 45° condition (p < 0.009) and the 60° condition (p < 0.001), and in the 45° condition than the 60° condition (p < 0.03). Overall peak lateral head and trunk displacements and knee-head forward distance were slightly greater in the standard than the lightweight BPB (p < 0.04), however these differences between BPBs were small (∼10 mm). Shoulder belt peak load decreased as the reclined seatback angle increased (p < 0.03): the shoulder belt peak load was statistically greater in the 25° condition than the 60° condition (p < 0.02). Muscle activation from the neck, upper trunk, and lower legs showed great activation. Neck muscles activation increased with the increase in seatback recline angle. Thighs, upper arms, and abdominal muscles showed small activation and no effect of conditions. Child volunteers showed decreased displacement suggesting that reclined seatbacks placed the booster-seated children in a more favorable position within the shoulder belt in a low-acceleration lateral-oblique impact, compared to nominal seatback angles. BPB type seemed to minimally influence the children's motion: the small differences found may have been due to the slight difference in heights between the two BPBs. Future research with more severe pulses is needed to better understand reclined children's motion in far-side lateral-oblique impacts.

The effect of a startle-based warning, age, sex, and secondary task on takeover actions in critical autonomous driving scenarios

Introduction: In highly autonomous driving scenarios, it is critical to identify strategies to accelerate reaction times since drivers may take too long to take over control of the vehicle. Previous studies reported that an Acoustic Startling Pre-Stimulus (ASPS, i.e., a loud warning preceding an action) accelerated reaction times in simple ankle flexion exercises.

Methods: In this study, we examined if an ASPS warning leads to shorter takeover reaction times in a sled-simulated evasive swerving maneuver. Twenty-eight participants (seven male adults, seven male teenagers, seven female adults, and seven female teenagers) were instructed to align a marker on the steering wheel with a marker on a lateral post as fast as they could as soon as the lateral sled perturbation (0.75 g) started. Four conditions were examined: with and without an ASPS (105 dB, played 250 ms before sled perturbation for 40 ms), and with and without a secondary task (i.e., texting). A catch trial (ASPS only) was used to minimize anticipation. Human kinematics were captured with an 8-camera 3D motion capture system.

Results: Results showed that the drivers’ hands lifted towards the steering wheel more quickly with the ASPS (169 ± 55 ms) than without (194 ± 46 ms; p = 0.01), and that adult drivers touched the steering wheel quicker with the ASPS (435 ± 54 ms) than without (470 ± 33 ms; p = 0.01). Similar findings were not observed for the teen drivers. Additionally, female drivers were found to lift their hands towards the steering wheel faster than male drivers (166 ± 58 ms vs. 199 ± 36 ms; p = 0.009).

Discussion: Our findings suggest that the ASPS may be beneficial to accelerate driver reaction times during the initiation of a correction maneuver, and that autonomous vehicle warnings may need to be tailored to the age and sex of the driver.

Repositioning forward-leaning vehicle occupants with a pre-pretensioner belt and a startle-based warning in pre-crash scenarios

OBJECTIVE

Pre-pretensioner (PPT) seatbelts have been found to be effective in controlling vehicle occupants' motion response to disturbances in optimally positioned occupants, but it is not clear how the PPT performs when the occupant is initially forward leaning. Previous work demonstrated that an acoustic startling pre-stimulus (ASPS) reduced trunk out-of-position in sled-simulated pre-crash maneuvers. Therefore, the aim of this study was to determine if coupling the PPT with the ASPS could reduce the needed magnitude and rate of belt tension of the PPT to reposition forward leaning occupants to their optimal position within the seatbelt.

METHODS

Sixteen belt-restrained adult human volunteers (8 males and 8 females) restrained by a 3-point seatbelt on a vehicle seat in a forward leaning posture on a sled simulating pre-crash braking (approx. 1 g of maximum acceleration and 0.3 s duration) were exposed to sled perturbations with three belt configurations (low and high force PPT and no PPT), and two warning conditions (ASPS and no-ASPS). Head and trunk positions were extracted from the 3D motion-capture data. Repeated measure ANOVAs were used to understand the effect of sex, PPT, ASPS, and repetition on head and trunk positions. A survival analysis was also performed to understand the probability of the occupants moving rearward in the different conditions.

RESULTS

The probability of the head and trunk to move rearward from the initial position was greater with the PPT than without the PPT (p = 0.01) and with the high force level than the low force level (p = 0.01). The interaction effect of ASPS x PPT showed that with no PPT, there was a greater probability for the head to move rearward from the initial position with ASPS than without ASPS (p < 0.03). The trunk shows a similar trend to the head, but the ASPS vs no-ASPS differences were not statistically significant (p = 0.06). No sex differences were found.

CONCLUSIONS

The PPT, particularly the high level, may be an effective countermeasure on its own to reduce trunk and head out-of-position in forward leaning postures in pre-crash scenarios. The ASPS reduced the occupants' head forward position when the PPT was not available.

Cervical Muscle Activation Characteristics and Head Kinematics in Males and Females Following Acoustic Warnings and Impulsive Head Forces

Sex, head and neck posture, and cervical muscle preparation are contributing factors in the severity of head and neck injuries. However, it is unknown how these factors modulate the head kinematics. In this study, twenty-four (16 male and 8 female) participants experienced 50 impulsive forces to their heads with and without an acoustic warning. Female participants demonstrated a 71 ms faster (p = 0.002) muscle activation onset compared to males after warning. The magnitude of muscle activation was not significant between sexes. Females exhibited 21% (p < 0.008) greater peak angular velocity in all force directions and 18% (p < 0.04) greater peak angular acceleration in sagittal plane compared to males. Females exhibited 15% (p = 0.03) greater peak linear acceleration compared to males only in sagittal flexion. Preparation attenuated head kinematics significantly (p < 0.03) in 11 out of 18 investigated head kinematics for both sexes. A warning eliciting a startle response 420 ms prior to the impact resulted in significant attenuation of all measured head kinematics in sagittal extension (p < 0.037). In conclusion, both sex and warning type were significant factors in head kinematics. These data provide insight into the complex relationship of muscle activation and sex, and may help identify innovative strategies to reduce head and neck injury risk in sports.

Surface Electromyography Study Using a Low-Cost System: Are There Neck Muscles Differences When the Passenger Is Warned during an Emergency Braking Inside an Autonomous Vehicle?

Deaths and serious injuries caused by traffic accidents is a concerning public health problem. However, the problem can be mitigated by the Autonomous Emergency Braking (AEB) system, which can avoid the impact. The market penetration of AEB is exponentially growing, and non-impact situations are expected to become more frequent. Thus, new injury patterns must be analysed, and the neck is particularly sensitive to sudden acceleration changes. Abrupt braking would be enough to be a potential risk for cervical spine injury. There is controversy about whether or not there are differences in cervical behaviour depending on whether passengers are relaxed or contract their muscles before the imminent accident. In the present manuscript, 18 volunteers were subjected to two different levels of awareness during an emergency braking test. Cervical muscles (sternocleidomastoid and trapezius) were analysed by the sEMG signal captured by means of a low-cost system. The differences observed in the muscle response according to gender and age were notable when passengers are warned. Gender differences were more significant in the post-braking phase. When passengers were relaxed, subjects older than 35 registered higher sEMG values. Meanwhile, when passengers contract their muscles, subjects who were younger than or equal to 35 years old experienced an increment in the values of the sEMG signals.

Cervical Muscle Activation Due to an Applied Force in Response to Different Types of Acoustic Warnings

Mild traumatic brain injury (mTBI) and whiplash-associated disorder are the most common head and neck injuries and result from a sudden head or body acceleration. The head and neck injury potential is correlated with the awareness, level of muscle activation, and posture changes at the time of the perturbation. Environmental acoustic stimuli or a warning system can influence muscle activation and posture during a head perturbation. In this study, different acoustic stimuli, including Non-Directional, Directional, and Startle, were provided 1000 ms before a head impact, and the amplitude and timing of cervical muscle electromyographic (EMG) data were characterized based on the type of warning. The startle warning resulted in 49% faster and 80% greater EMG amplitude compared to the Directional and Non-Directional warnings after warning and before the impact. The post-impact peak EMG amplitudes in Unwarned trials were lower by 18 and 21% in the retraction and rebound muscle groups, respectively, compared to any of the warned conditions. When there was no warning before the impact, the retraction and rebound muscle groups also reached their maximum activation 38 and 54 ms sooner, respectively, compared to the warned trials. Based on these results, the intensity and complexity of information that a warning sound carries change the muscle response before and after a head impact and has implications for injury potential.

Acoustic pre-stimulation modulates startle and postural reactions during sudden release of standing support surface in aging

Falls contribute to injuries and reduced level of physical activity in older adults. During falls, the abrupt sensation of moving downward triggers a startle-like reaction that may interfere with protective response movements necessary to maintain balance. Startle reaction could be dampened by sensory pre-stimulation delivered immediately before a startling stimulus. This study investigated the neuromodulatory effects of pre-stimulation on postural/startle responses to drop perturbations of the standing support surface in relation to age. Ten younger and 10 older adults stood quietly on an elevated computer-controlled moveable platform. At an unpredictable time, participants were dropped vertically to elicit a startle-like response. Reactive drop perturbation trials without a pre-stimulus (control) were alternated with trials with acoustic pre-stimulus tone (PSI). A two-way mixed design analysis of variance comparing condition (control vs. PSI) X group (younger vs. older) was performed to analyze changes in muscle activation patterns, ground reaction force, and joint angular displacements. Compared to younger adults, older adults showed lower neck muscle electromyography amplitude reduction rate and incidence of response. Peak muscle activation in neck, upper arm, and hamstring muscles were reduced during PSI trials compared to control trials in both groups (p < 0.05). In addition, knee and hip joint flexion prior to ground contact was reduced in PSI trials compared to control (p < 0.05). During post-landing balance recovery, increased knee and hip flexion displacement and time to peak impact force were observed in PSI trials compared to control condition (p < 0.05). PSI reduced startle-induced muscle activation at proximal body segments and likely decreased joint flexion during abrupt downward vertical displacement perturbations of the body. Older adults retained the ability to modulate startle and postural responses but their neuromodulatory capacity was reduced compared with younger adults. Further research on the potential of applying PSI as a possible therapeutic tool to reduce the risk of fall-related injury is needed.

Neck Muscle and Head/Neck Kinematic Responses While Bracing Against the Steering Wheel During Front and Rear Impacts

Drivers often react to an impending collision by bracing against the steering wheel. The goal of the present study was to quantify the effect of bracing on neck muscle activity and head/torso kinematics during low-speed front and rear impacts. Eleven seated subjects (3F, 8 M) experienced multiple sled impacts (Δv = 0.77 m/s; a_peak = 19.9 m/s², Δt = 65.5 ms) with their hands on the steering wheel in two conditions: relaxed and braced against the steering wheel. Electromyographic activity in eight neck muscles (sternohyoid, sternocleidomastoid, splenius capitis, semispinalis capitis, semispinalis cervicis, multifidus, levator scapulae, and trapezius) was recorded unilaterally with indwelling electrodes and normalized by maximum voluntary contraction (MVC) levels. Head and torso kinematics (linear acceleration, angular velocity, angular rotation, and retraction) were measured with sensors and motion tracking. Muscle and kinematic variables were compared between the relaxed and braced conditions using linear mixed models. We found that pre-impact bracing generated only small increases in the pre-impact muscle activity (< 5% MVC) when compared to the relaxed condition. Pre-impact bracing did not increase peak neck muscle responses during the impacts; instead it reduced peak trapezius and multifidus muscle activity by about half during front impacts. Bracing led to widespread changes in the peak amplitude and timing of the torso and head kinematics that were not consistent with a simple stiffening of the head/neck/torso system. Instead pre-impact bracing served to couple the torso more rigidly to the seat while not necessarily coupling the head more rigidly to the torso.

Study of the Emergency Braking Test with an Autonomous Bus and the sEMG Neck Response by Means of a Low-Cost System

Nowadays, due to the advances and the increasing implementation of the autonomous braking systems in vehicles, the non-collision accident is expected to become more common than a crash when a sudden stop happens. The most common injury in this kind of accident is whiplash or cervical injury since the neck has high sensitivity to sharp deceleration. To date, biomechanical research has usually been developed inside laboratories and does not entirely represent real conditions (e.g., restraint systems or surroundings of the experiment). With the aim of knowing the possible neck effects and consequences of an automatic emergency braking inside an autonomous bus, a surface electromyography (sEMG) system built by low-cost elements and developed by us, in tandem with other devices, such as accelerometers or cameras, were used. Moreover, thanks to the collaboration of 18 participants, it was possible to study the non-collision effects in two different scenarios (braking test in which the passenger is seated and looking ahead while talking with somebody in front of him (BT1) and, a second braking test where the passenger used a smartphone (BT2) and nobody is seated in front of him talking to him). The aim was to assess the sEMG neck response in the most common situations when somebody uses some kind of transport in order to conclude which environments are riskier regarding a possible cervical injury.

Optimization of Female Head-Neck Model with Active Reflexive Cervical Muscles in Low Severity Rear Impact Collisions

ViVA Open Human Body Model (HBM) is an open-source human body model that was developed to fill the gap of currently available models that lacked the average female size. In this study, the head–neck model of ViVA OpenHBM was further developed by adding active muscle controllers for the cervical muscles to represent the human neck muscle reflex system as studies have shown that cervical muscles influence head–neck kinematics during impacts. The muscle controller was calibrated by conducting optimization-based parameter identification of published-volunteer data. The effects of different calibration objectives to head–neck kinematics were analyzed and compared. In general, a model with active neck muscles improved the head–neck kinematics agreement with volunteer responses. The current study highlights the importance of including active muscle response to mimic the volunteer’s kinematics. A simple PD controller has found to be able to represent the behavior of the neck muscle reflex system. The optimum gains that defined the muscle controllers in the present study were able to be identified using optimizations. The present study provides a basis for describing an active muscle controller that can be used in future studies to investigate whiplash injuries in rear impacts

Comparison of control strategies for the cervical muscles of an average female head-neck finite element model

Objective: ViVA OpenHBM is the first open source Human Body Model (HBM) for crash safety assessment. It represents an average size (50th percentile) female and was created to assess whiplash protection systems in a car. To increase the biofidelity of the current model, further enhancements are being made by implementing muscle reflex response capabilities as cervical muscles alter the head and neck kinematics of the occupant during low-speed rear crashes. The objective of this study was to assess how different neck muscle activation control strategies affect head-neck kinematics in low speed rear impacts.Methods: The VIVA OpenHBM head-neck model, previously validated to PMHS data, was used for this study. To represent the 34 cervical muscles, 129 beam elements with Hill-type material models were used. Two different muscle activation control strategies were implemented: a control strategy to mimic neural feedback from the vestibular system and a control strategy to represent displacement feedback from muscle spindles. To identify control gain values for these controller strategies, parameter calibrations were conducted using optimization. The objective of these optimizations was to match the head linear and angular displacements measured in volunteer tests.Results: Muscle activation changed the head kinematics by reducing the peak linear displacements, as compared to the model without muscle activation. For the muscle activation model mimicking the human vestibular system, a good agreement was observed for the horizontal head translation. However, in the vertical direction there was a discrepancy of head kinematic response caused by buckling of the cervical spine. In the model with a control strategy that represents muscle spindle feedback, improvements in translational head kinematics were observed and less cervical spine buckling was observed. Although, the overall kinematic responses were better in the first strategy.Conclusions: Both muscle control strategies improved the head kinematics compared to the passive model and comparable to the volunteer kinematics responses with overall better agreement achieved by the model with active muscles mimicking the human vestibular system.

Aging changes in protective balance and startle responses to sudden drop perturbations

This study investigated aging changes in protective balance and startle responses to sudden drop perturbations and their effect on landing impact forces (vertical ground reaction forces, vGRF) and balance stability. Twelve healthy older (6 men; mean age = 72.5 ± 2.32 yr, mean ± SE) and 12 younger adults (7 men; mean age = 28.09 ± 1.03 yr) stood atop a moveable platform and received externally triggered drop perturbations of the support surface. Electromyographic activity was recorded bilaterally over the sternocleidomastoid (SCM), middle deltoid, biceps brachii, vastus lateralis (VL), biceps femoris (BF), medial gastrocnemius (MG), and tibialis anterior (TA). Whole body kinematics were recorded with motion analysis. Stability in the anteroposterior direction was quantified using the margin of stability (MoS). Incidence of early onset of bilateral SCM activation within 120 ms after drop onset was present during the first-trial response (FTR) for all participants. Co-contraction indexes during FTRs between VL and BF as well as TA and MG were significantly greater in the older group (VL/BF by 26%, P < 0.05; TA/MG by 37%, P < 0.05). Reduced shoulder abduction between FTR and last-trial responses, indicative of habituation, was present across both groups. Significant age-related differences in landing strategy were present between groups, because older adults had greater trunk flexion (P < 0.05) and less knee flexion (P < 0.05) that resulted in greater peak vGRFs and decreased MoS compared with younger adults. These findings suggest age-associated abnormalities of delayed, exaggerated, and poorly habituated startle/postural FTRs are linked with greater landing impact force and diminished balance stabilization. NEW & NOTEWORTHY This study investigated the role of startle as a pathophysiological mechanism contributing to balance impairment in aging. We measured neuromotor responses as younger and older adults stood on a platform that dropped unexpectedly. Group differences in landing strategies indicated age-associated abnormalities of delayed, exaggerated, and poorly habituated startle/postural responses linked with a higher magnitude of impact force and decreased balance stabilization. The findings have implications for determining mechanisms contributing to falls and related injuries.

Aging effects of motor prediction on protective balance and startle responses to sudden drop perturbations

This pilot study investigated the effect of age on the ability of motor prediction during self-triggered drop perturbations (SLF) to modulate startle-like first trial response (FTR) magnitude during externally-triggered (EXT) drop perturbations. Ten healthy older (71.4 ± 1.44 years) and younger adults (26.2 ± 1.63 years) stood atop a moveable platform and received blocks of twelve consecutive EXT and SLF drop perturbations. Following the last SLF trial, participants received an additional EXT trial spaced 20 min apart to assess retention (EXT RTN) of any modulation effects. Electromyographic (EMG) activity was recorded bilaterally over the sternocleidomastoid (SCM), vastus lateralis (VL), biceps femoris (BF), medial gastrocnemius (MG), and tibialis anterior (TA). Whole-body kinematics and kinetic data were recorded. Stability in the antero-posterior direction was quantified using the margin of stability (MoS). Compared with EXT trials, both groups reduced SCM peak amplitude responses during SLF and EXT RTN trials. VL/BF and TA/MG coactivation were reduced during SLF FTR compared to EXT FTR (p < 0.05) with reduced peak vertical ground reaction forces (vGRF) in both younger and older adults (p < 0.05). Older adults increased their MoS during SLF FTR compared to EXT FTR (p < 0.05). Both groups performed more eccentric work during SLF trials compared to EXT (p < 0.05). These findings indicate that abnormal startle effects with aging may interfere with balance recovery and increase risk of injury with external balance perturbations. Motor prediction may be used to acutely mitigate abnormal startle/postural responses with aging.

Neck muscle responses of driver and front seat passenger during frontal-oblique collisions

BACKGROUND

Low-velocity motor vehicle crashes often lead to severe and chronic neck disorders also referred to as whiplash-associated disorders (WAD). The etiology of WAD is still not fully understood. Many studies using a real or simulated collision scenario have focused on rear-end collisions, whereas the kinematics and muscular responses during frontal-oblique collisions have hardly been investigated. In particular for rear-end collisions, drivers were shown to have a higher WAD risk than front seat passengers. Yet, independently from the impact direction, neither the muscular nor the kinematic responses of drivers and front seat passengers have been compared to date, although some findings indicate that the neck muscles have the potential to alter the head and neck kinematics, and that the level of neck muscle activity during impact may be relevant for the emergence of WAD.

OBJECTIVE

In this study, we quantitatively examined the subjects' neck muscle activity during low-velocity left-frontal-oblique impacts to gain further insights into the neuromuscular mechanism underlying whiplash-like perturbations that may lead to WAD.

METHODS

In a within-subject study design, we varied several impact parameters to investigate their effect on neck muscle response amplitude and delay. Fifty-two subjects experienced at least ten collisions while controlling for the following parameters: change in velocity Δv (3 / 6 km/h), seating position (driver / front seat passenger), and deliberate pre-tension of the musculature (tense / relaxed) to account for a potential difference between an expected and an unexpected crash. Ten of the 52 subjects additionally ran the same experimental conditions as above, but without wearing a safety belt.

FINDINGS

There were significant main effects of Δv and muscle pre-tension on the reflex amplitude but not of seating position. As for the reflex delay, there was a significant main effect of muscle pre-tension, but neither of Δv nor of seating position. Moreover, neither the safety belt nor its asymmetrical orientation had an influence on the reflexive responses of the occupants.

CONCLUSION

In summary, we did not find any significant differences in the reflex amplitude and delay of the neck musculature between drivers and front seat passengers. We therefore concluded that an increased risk of the driver sustaining WAD in frontal-oblique collisions, if it exists, cannot be due to differences in the reflexive responses.

Decreased postural control in people with moderate hearing loss

Balance is a complex process that involves multiple sensory integrations. The auditory, visual, and vestibular systems are the main contributors. Hearing loss or hearing impairment may induce inappropriate postural strategies that could affect balance and therefore increase the risk of falling.The aim of this study was to understand whether hearing loss could influence balance, cervical posture, and muscle activation in the cervical region.Thirteen patients (61 ± 13 years; 161.8 ± 11.0 cm; 70.5 ± 15.9 kg) with moderate hearing loss (Right ear -60 ± 21 dB; Left ear -61 ± 24 dB) underwent: an audiometric examination, a postural examination (with open and closed eyes) through a stabilometric platform, a cervical ROM examination through a head accelerometer, and a sternocleidomastoid electromyography (EMG) examination.A linear regression analysis has shown a regression coefficient (R) 0.76 and 0.69 between hearing loss and the posturographic parameters, on the sagittal sway, with open and closed eyes, respectively. The combination of frontal and sagittal sway is able to explain up to 84% of the variance of the audiometric assessment. No differences were found between right and left hemibody between the audiometric, posturographic, cervical ROM parameters, and in EMG amplitude. ROM and EMG parameters have not shown any significant associations with hearing loss, for both right and left head rotation.Hearing loss is associated to increased posturographic measures, especially the sagittal sway, underlining a reduced postural control in people with hearing impairments. No association was found between the heads posture and neck activation with hearing loss. Hearing loss may be associated with an increased risk of falls.

What startles tell us about control of posture and gait

Recently, there has been an increase in studies evaluating startle reflexes and StartReact, many in tasks involving postural control and gait. These studies have provided important new insights. First, several experiments indicate a superimposition of startle reflex activity on the postural response during unexpected balance perturbations. Overlap in the expression of startle reflexes and postural responses emphasizes the possibility of, at least partly, a common substrate for these two types of behavior. Second, it is recognized that the range of behaviors, susceptible to StartReact, has expanded considerably. Originally this work was concentrated on simple voluntary ballistic movements, but gait initiation, online step adjustments and postural responses can be initiated earlier by a startling stimulus as well, indicating advanced motor preparation of posture and gait. Third, recent experiments on StartReact using TMS and patients with corticospinal lesions suggest that this motor preparation involves a close interaction between cortical and subcortical structures. In this review, we provide a comprehensive overview on startle reflexes, StartReact, and their interaction with posture and gait.

Loud preimpact tones reduce the cervical multifidus muscle response during rear-end collisions: a potential method for reducing whiplash injuries

BACKGROUND CONTEXT

Neck muscle responses after unexpected rear-end collisions consist of a stereotypical combination of postural and startle responses. Prior work using surface electromyography (EMG) has shown that the superficial neck muscle responses can be attenuated when a loud tone (105 dB) is presented 250 milliseconds before impact, but the accompanying response of the deeper multifidus muscles remains unknown. Quantifying this response in multifidus is important because this muscle attaches directly to the cervical facet capsule and can potentially increase the strain in the capsule during an impact and contribute to whiplash injury.

PURPOSE

To investigate if a loud preimpact tone decreases the cervical multifidus muscle response during rear-end perturbations.

STUDY DESIGN

After approval by the University Clinical Ethics Review Board, human volunteers experienced a series of three whiplash-like perturbations.

PATIENT SAMPLE

Twelve subjects with no history of neurologic disorders or whiplash injury were recruited to participate in this experiment.

OUTCOME MEASURES

Bilateral indwelling EMG of multifidus at the C4 and C6 levels, surface EMG of sternocleidomastoid (SCM) and C4 paraspinals (PARAs), and kinematics of the head/neck were measured.

METHODS

Subjects experienced three whiplash-like perturbations (peak acceleration of 19.5 m/s(2)) preceded by either no tone or a loud tone (105 dB) presented 250 milliseconds before sled acceleration onset.

RESULTS

The loud tone decreased the muscle activity of C6 multifidus (42%) and C4 PARAs (30%), but did not affect the C4 multifidus or SCM activity. Peak head kinematic responses (extension angle: 6%, retraction: 9%, linear forward acceleration: 9%, and angular acceleration in extension: 13%) were also decreased by the loud preimpact tone.

CONCLUSIONS

The attenuation of peak C6 multifidus activity and head kinematic responses suggests that a loud preimpact tone may reduce the strain in the cervical facet capsule, which may reduce the risk of whiplash injury during rear-end collisions.

Protective balance and startle responses to sudden freefall in standing humans

The aim of the present study was to investigate whether or not startle reactions contribute to the whole body postural responses following sudden freefall in standing humans. Nine healthy participants stood atop a moveable platform and received externally-triggered (EXT) and selftriggered (SLF) drop perturbations of the support surface. Electromyographic (EMG) activity was recorded bilaterally over the sternocleidomastoid (SCM), deltoid (DLT), biceps brachii (BIC), medial gastrocnemius (GAS), and tibialis anterior (TA) muscles. Whole-body kinematics were also recorded with motion analysis. Rapid phasic activation of SCM during the first trial response (FTR) was seen for all participants for EXT and for 56% of subjects for SLF. Reductions in EMG amplitude between the EXT FTR and later trial responses for SCM, DLT, and BIC and reduced arm movement acceleration indicative of habituation occurred and exceeded adaptive reductions for SLF. These findings suggested that a startle reflex contributes to the exaggerated postural FTR observed during externally-triggered whole-body free falls.