Chantelle D. Murnaghan

Shifting the balance: evidence of an exploratory role for postural sway.

Humans and other species are unable to stand perfectly still; their bodies continuously sway during stance even during concentrated efforts to avoid such movement. Traditionally, this phenomenon has been viewed as an inability of the central nervous system (CNS) to maintain perfect equilibrium because of its reliance on feedback from sensory signals to control corrective ground-reaction forces. Using a novel method to minimize movements of the body during stance without subject awareness, we have made the unique discovery that ground-reaction forces are generated independent of body sway, as evidenced by observations of increased centre of pressure variability when postural sway is minimized experimentally. Contrary to traditional views, our results suggest that postural sway may be used by the CNS as an exploratory mechanism to ensure that continuous dynamic inputs are provided by multiple sensory systems. This novel paradigm has the potential to significantly shift long-standing views on balance, and questions the theoretical basis behind conventional treatment strategies for balance deficits associated with age and disease.

Motor Unit Rotation in a Variety of Human Muscles

The phenomena of substitution and rotation among motor units of a muscle were examined in seven different muscles. Intramuscular motor unit activity and surface electromyographic (EMG) activity were recorded from one of the following muscles: abductor digiti minimi, first dorsal interosseous, extensor digitorum communis, flexor and extensor carpi radialis, tibialis anterior, and soleus. The subject was asked to discharge a discernible unit at a comfortable constant or rhythmically (pseudosinusoidally) modulated rate with audio and visual feedback. Results are reported from a total of 42 sets of motor units from all seven muscles. We observed that when a subject fired a motor unit for a long period, an additional motor unit frequently started to discharge after a few minutes. When the subject was asked to keep activity down to one unit, very often it was Unit 1 that dropped and Unit 2 continued to fire. Whereas Unit 2 had fired for a few minutes, Unit 1 resumed firing without any conscious effort by the subject. If the subject was then asked to retain just one unit, it was Unit 2 that dropped. Rhythmic modulation of firing rate of a tonically firing unit showed that whereas the threshold of this unit increased, the threshold of a phasically discharging unit decreased substantially. The increase in threshold of a tonically discharging unit is suggested to arise from inactivation of Na(+) and Ca(2+) channels and the decrease in threshold of higher-threshold units is suggested to arise from an increase in persistent inward currents that may occur during prolonged contractions. Whether a unit stops or starts to fire is suggested to depend on a balance between the strength of the central motor command, persistent inward currents, and inactivation of voltage-gated channels. Such rotations among low-threshold motoneurons would ensure low-level sustained contractions to be viable not only in small hand muscles but also in larger limb muscles.

Effects of postural threat on spinal stretch reflexes: evidence for increased muscle spindle sensitivity?

Standing balance is often threatened in everyday life. These threats typically involve scenarios in which either the likelihood or the consequence of falling is higher than normal. When cats are placed in these scenarios they respond by increasing the sensitivity of muscle spindles imbedded in the leg muscles, presumably to increase balance-relevant afferent information available to the nervous system. At present, it is unknown whether humans also respond to such postural threats by altering muscle spindle sensitivity. Here we present two studies that probed the effects of postural threat on spinal stretch reflexes. In study 1 we manipulated the threat associated with an increased consequence of a fall by having subjects stand at the edge of an elevated surface (3.2 m). In study 2 we manipulated the threat by increasing the likelihood of a fall by occasionally tilting the support surface on which subjects stood. In both scenarios we used Hoffmann (H) and tendon stretch (T) reflexes to probe the spinal stretch reflex circuit of the soleus muscle. We observed increased T-reflex amplitudes and unchanged H-reflex amplitudes in both threat scenarios. These results suggest that the synaptic state of the spinal stretch reflex is unaffected by postural threat and that therefore the muscle spindles activated in the T-reflexes must be more sensitive in the threatening conditions. We propose that this increase in sensitivity may function to satisfy the conflicting needs to restrict movement with threat, while maintaining a certain amount of sensory information related to postural control.

Balance problems with Parkinson's disease: are they anxiety-dependent?

Non-motor symptoms, such as fear of falling and anxiety, are frequently reported in Parkinsons disease (PD). Recent evidence of anxiety and fear directly influencing balance control in healthy young and older adults, raises the question whether fear of falling and anxiety also directly contribute to the balance deficits observed in PD. The goal of the current study was to examine whether PD patients and controls responded similarly or differently to experimentally induced increases in anxiety. For this purpose, 14 PD patients (tested during a subjective optimal ON state) and 16 healthy age-matched control subjects stood in three conditions of different levels of postural threat: normal threat (quiet standing at ground level); medium threat (standing at the edge of a surface elevated to 80 cm); and high threat (same, but to 160 cm). Outcome measures included mean position, mean power of frequency (MPF) and root mean square (RMS) of centre of pressure (COP) displacements in the anterior-posterior (AP) and medial-lateral (ML) directions. Physiological and psychosocial measures of fear and anxiety were also recorded. Increased threat changed postural control similarly in PD patients and controls; MPF of AP and ML COP increased and the mean COP position was shifted backward in both groups. These results indicate that during the ON state, static balance in PD patients and controls is equally susceptible to the influence of anxiety. Significant correlations observed between COP changes and measures of fear and anxiety provide evidence to support the proposed neural links between structures controlling emotion and postural control. Future studies should further address this issue by including more severely affected patients, by testing the influence of dopaminergic medication, by including more anxious patients, and by using dynamic measures of balance.

Are increases in COP variability observed when participants are provided explicit verbal cues prior to COM stabilization

Previous research has shown that when the COM is stabilized without participant awareness, COP displacements increase. This finding suggests that postural sway under normal conditions may be exploratory and used as a means of acquiring sensory information. However, based on the theory that posture is controlled using internal models, it could be argued that increases in COP displacement reflect errors that arise as the central nervous system attempts to adapt the internal model used to control posture to the new conditions. The current study provided an explicit verbal cue to the participants indicating how and when COM stabilization would occur. Based on evidence suggesting that explicit verbal cues can reduce errors when the dynamics of the task are altered, we hypothesized that when participants were aware of COM stabilization, COP displacements would be reduced. However, we found that anterior-posterior COP displacements increased independent of cueing, suggesting that increases in COP displacements with locking were not the result of an attempt to adapt the internal model of postural control. The results provide further support for an exploratory role of postural sway.