Posturography

Static postural control does not strongly predict dynamic gait stability recovery following a trip in adults with and without vestibular dysfunction

Unilateral peripheral vestibular disorder (UPVD) negatively affects upper and lower body motor performance, but postural control during quiet stance in UPVD patients has not been directly compared with dynamic stability control after an unexpected perturbation during locomotion. We analysed centre of pressure (COP) characteristics during static posturography in UPVD patients and healthy controls and compared this with performance of a trip recovery task. 17 UPVD patients and 17 healthy controls were unexpectedly tripped while walking on a treadmill. The margin of stability (MoS) was calculated at touchdown (TD) of the perturbed step and the first six recovery steps. Posturography was used to assess postural stability during 30 seconds of standing with eyes open and closed using a force plate. The trip reduced the MoS of the perturbed leg (p<0.05) with no significant differences in MoS between the groups. Controls returned to MoS baseline level in five steps and patients did not return within the six steps. UPVD patients showed a greater total COP sway path excursion (closed eyes only), anterior-posterior range of COP distance and a more posterior COP position in relation to the posterior boundary of the base of support. There were no significant correlations between COP sway path excursion and MoS values. We concluded that UPVD patients have a diminished ability to control and recover dynamic gait stability after an unexpected trip and lower static postural stability control compared to healthy matched controls, but that trip recovery and static postural control rely on different control mechanisms.
Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy, Posturography


Postural Responses to Noisy Support Surface Translations in Stroke Survivors

Healthy standing posture is characterized by the ability to interact with a changing environment while maintaining upright stance. Being adaptable to changing environments affords flexibility and allows the system to encounter novel environments without losing control of posture. The purpose of this research was to determine if stroke survivors could adapt to support surface translations with differing temporal structures. Methods: Eight stroke survivors participated in this research. Participants stood on a force platform on the Neurocom Balance Manager (Neurocom Intl., Clackamas, OR, USA). The support surface was translated in the anteroposterior direction according to waveforms with different temporal structures, this included white noise, pink noise, brown noise, and a sine wave. They also performed a normal standing trial where the platform did not move. Root mean square and detrended fluctuation analysis of the center of pressure signal were calculated to determine amount and temporal structure of variability respectively. Results: During normal standing the stroke survivors’ posture exhibited lack of adaptability. The stroke survivors had increased amount of variability in all conditions compared to normal standing, regardless of the inherent structure of the support surface translations. The temporal structure of variability indicated weakened long-range correlations in all conditions compared to normal standing. This indicates that regardless of the temporal structure of the support surface movement the amount of movement increased while the structure of movement became more random. Previous work has demonstrated that healthy posture is able to adapt to the temporal structure of support surface translations, this adaptability was not seen in a population of stroke survivors. This lack of adaptability makes interactions with environmental perturbations difficult and impacts functionality. Focusing rehabilitation protocols towards regaining healthy temporal structures in postural control could improve functionality in chronic stroke survivors.
Listed In: Biomechanics, Posturography


Auditory Cues on Postural Control in Parkinson&#039;s Disease: A Pilot Study

Objective: To evaluate the effect of auditory cues toward postural control in patients with Parkinson's disease (PD). Background: Auditory cues have been proved to be one of rehabilitation strategies for PD [1]. Most of Parkinson's Disease patients present postural instabilities regarding the severity of the disease [2, 3]. Rhythmic Auditory Stimulation (RAS) has been justified to be a standardized neurological motor therapy (NMTs) in PD, which cue-ing benefits may be associated with the activation of cerebellum-thalamic-cortical circuitry [4]. A potential method to stimulate the putamen that might help regulate PD brain's circuits could be providing music as a rhythmical cue [4]. A distinct manifestation in PD is also the arm swing reduction [5] which limits the capability of maintaining balance. It is rare to explore the static standing balance in Parkinson's Disease. Methods: 5 idiopathic PD patients (5 female) aged 72.6 ± 2.51 years, duration of the disease 15 ± 1.22 years (mean ± SD), H&Y 2.5-3 participated in this study. They were recruited from Yawata Medical Center, Ishikawa, Japan in June and November, 2014. The subjects were instructed to stand on the balance platform (Nintendo Wii Fit) and swing arm; Alternation (Alt) and Synchronization (Syn) in 3 scenarios; with no auditory cues (AC), with AC 5% increased and with AC 5 % decreased. The data were analyzed by Wilcoxon Signed Ranks Test and the dimensional clustering method [6] on MATLAB. Results: Tempo at 95% improved area, RMS and Min ML in Alternation, and decreased the path length in rest 2. Tempo at 105% decreased area and RMS in rest 2 statistically significant. A case with H&Y stage 3 showed poorer postural control in both Antero-Posterior (AP) and Medio-Lateral (ML) directions. Most cases presented the higher Center of Pressure (CoP) displacement in ML direction. AC with arm swing regulated the pattern of CoP trajectories. Conclusions: Auditory cues with arm swing - Alternation improved postural control in the PD patients. This concept might be considered clinically to be a rehabilitation program for Parkinson's disease (PD) to improve standing balance. It is a need to enlarge the sample size and develop more rehabilitation programs for improving balance in PD.
Listed In: Physical Therapy, Posturography


Are static and dynamic squatting activities comparable?

Background: Numerous studies have described 3D kinematics, 3D kinetics and electromyography (EMG) of the lower limb during quasi-static or dynamic squatting activities. However there is only little information on the comparison of these two squatting conditions. Only one study compared these activities in terms of 3D kinematics, but no information was available on 3D kinetics and EMG. The purpose of this study was to compare simultaneous recordings of 3D kinematics, 3D kinetics and EMG of the lower limb during quasi-static and fast dynamic squats. Methods: Ten subjects were recruited. 3D knee kinematics was recorded with a motion capture system, 3D kinetics was recorded with a force plate, and EMG of 8 muscles was recorded with surface electrodes. Each subject performed a quasi-static squat and several fast dynamic squats from 0° to 70° of knee flexion. Findings: Mean differences between quasi-static and dynamic squats were 1.6° for rotations, 1.8 mm for translations, 38 N ground reaction forces (2.1 % of subjects’ body weight), 6 Nm for torques, 13.0 mm for center of pressure, and 7 µV for EMG (6.3% of the maximum dynamic electromyographic activities ). Some significant differences (P < 0.05) were found in anterior-posterior translation, vertical forces and EMG. Interpretation: All differences found between quasi-static and fast dynamic squats can be considered small. 69.5% of the compared data were equivalent. In conclusion, this study show for the first time that quasi-static and dynamic squatting activities are comparable in terms of 3D kinematics, 3D kinetics and EMG.


Listed In: Biomechanical Engineering, Biomechanics, Gait, Orthopedic Research, Posturography


Suprathreshold Galvanic Vestibular Stimulation as an analog of vestibular dysfunction

In the past we have shown that exposure to increasing amplitudes of Galvanic vestibular stimulation (GVS) induces a corresponding increasing deficit in postural control, cognition and autonomic function. Previous studies have suggested that suprathreshold GVS induces a similar pattern of postural instability as the one observed on bilateral vestibular loss. The aim of the present study was to determine whether different current intensities would affect somatosensory, visual, and vestibular sensory system similarly to patient affected by vestibular deficits. We assessed postural control in unilateral (right and left) and bilateral vestibular loss patients, an aged matched healthy control group, and during pseudorandom binaural bipolar GVS in healthy subjects at one of three current amplitudes (1 mA, 3.5 mA, 5 mA). Balance was assessed with sensory organization test (SOT) that quantifies the effectiveness of vestibular, visual and somatosensory input to postural control. Results showed that GVS significantly affects vestibular control of posture compared to baseline at all current amplitudes, whereas somatosensory and visual performance was unaffected. Vestibular patients showed a significant decrease in vestibular and visual response compared to control. Suprathreshold GVS 5 mA showed a similar large effect size to unilateral and bilateral vestibular loss patients relative to their aged matched control. NASA NCC 9-58 and NNX09AL14G


Listed In: Biomechanical Engineering, Neuroscience, Posturography


Sensorimotor adaptation to Galvanic Vestibular Stimulation: a longitudinal study

Our previous study showed that exposure to Galvanic Vestibular Stimulation (GVS) induces temporary postural deficits similar to the ones experienced by astronauts after microgravity exposure. Preliminary evidence suggests that repeated exposures to GVS might induce adaptation of sway response. We studied whether repeated exposure to pseudorandom GVS over a 3 month period facilitates the adaptation response. Twenty healthy subjects were randomly assigned into 2 groups: suprathreshold (5mA) GVS, and subthreshold (1mA). The test battery included: Romberg, sensory organization test (posturography), dynamic visual acuity, and torsional eye movement. Each test was performed with no GVS, and then with 10 min of GVS per session for 12 consecutive weeks. Sensorimotor adaptation was also measured during two follow up sessions at weeks 18 and 36. Results showed that subthreshold GVS did not affect vestibular scores. Suprathreshold GVS significantly decreased vestibular scores during the first few weeks, with postural performance returning to baseline around the 6th week of exposure. This improvement was maintained during the follow up sessions. Our results suggest that 60 min of subthreshold GVS are sufficient to elicit adaptation to the stimulus. No significant changes were shown in low-level vestibulo-ocular reflexes during torsional eye movement, or vestibulo-spinal reflexes during Romberg; confirming that adaptation only occurs at the level of the CNS. NASA NCC 9-58; NNX09AL14G
Listed In: Biomechanical Engineering, Neuroscience, Posturography


Adaptive fractal analysis of postural sway

Fractal time series analysis methods are commonly used for analyzing center of pressure (COP) signals with the goal of revealing the underlying neuromuscular processes for upright stance control. The use of fractal methods is often coupled with the assumption that the COP is an instance of fractional Gaussian noise (fGn) or fractional Brownian motion (fBm). Our purpose was to evaluate the applicability of the fGn-fBm framework to the COP in light of several characteristics of COP signals revealed by a new method, adaptive fractal analysis (AFA; Riley et al., 2012). Our results showed that there are potentially three fractal scaling regions in the COP as opposed to one as expected from a pure fGn or fBm process. The scaling region at the fastest scale was anti-persistent and spanned ~30-90 msec, the intermediate was persistent and spanned ~200 msec-1.9 sec, and the slowest was anti-persistent and spanned ~5-40 sec. The intermediate fractal scaling region was the most clearly defined, but it only contributed around 11% of the total spectral energy of the COP signal, indicating that other features of the COP signal contribute more importantly to the overall dynamics. Also, more than half of the Hurst exponents estimated for the intermediate region were greater than the theoretically expected range [0,1] for fGn-fBm processes. These results suggest the fGn-fBm framework is not appropriate for modeling COP signals. ON-OFF intermittency might provide a better modeling framework for the COP, and multiscale approaches may be more appropriate for analyzing COP data.


Listed In: Neuroscience, Posturography