Helga Hirschfeld

Postural adjustments in sitting humans following external perturbations: muscle activity and kinematics

There are several controversies concerning the organization and induction of postural adjustments in standing humans. Some investigators suggest the responses are triggered by somatosensory inputs (especially from the ankle in standing subjects), while others emphasize the vestibular input induced by head acceleration. We examined postural responses in sitting subjects in order to describe the muscle activation pattern during various perturbations and to test whether somatosensory or vestibular stimulation elicited the responses. The kinematics and EMG patterns in respons to perturbations caused by movements of the support surface were studied in adults. The postural muscle activation following a backward sway was mainly the same, whether it was elicited by a forward translation or a legs-up rotation. This is remarkable, since, except for pelvis rotation, the movements of all body segments including the head differed in the two conditions. Furthermore, a second experiment showed that the direction of the initial head movement could be reversed with retainment of the same postural muscle activation pattern. The results suggest that somatosensory signals derived from the backward rotation of the pelvis, and not vestibular information from the head, trigger postural responses during sitting. There was a slight but consistent difference in the muscle activation pattern, whether the backward sway was elicited by a forward translation or legs-up rotation. The difference seemed to reflect the sensory information from head and other body parts (except the pelvis). This finding allowed us to speculate in a central pattern generator for postural adjustments containing two levels. At the first level, a simple format of the muscle activation would be generated; at the second level, the centrally generated pattern could be shaped and timed by interaction from the entire somatosensory, vestibular, and visual input.

THE DEVELOPMENT OF INDEPENDENT WALKING IN CHILDREN WITH CEREBRAL PALSY

Electromyographic and kinematic data were collected during treadmill locomotion by normal infants and infants with cerebral palsy. Locomotor patterns of the infants with cerebral palsy were similar to those of normal infants during the stage of supported locomotion, but as they matured, some of the characteristics of the infant stepping pattern, such as synchronous muscle activity with excessive muscular co‐contraction and short‐latency reflexes at foot contact, were retained. The normal plantigrade features of adult gait did not develop in these children.

DOES THE FUNCTIONAL REACH TEST REFLECT STABILITY LIMITS IN ELDERLY PEOPLE

OBJECTIVE To explore how the Functional Reach test correlates with the displacement of the centre of pressure and whether the test is a measure of the stability limits in healthy elderly people. Also to explore the performance parameters during the Functional Reach test. DESIGN Method comparison study. SUBJECTS Twenty-seven healthy elderly subjects. METHODS Whole body kinematics (ELITE systems), ground reaction forces (AMTI) and muscle activity (EMG) parallel with clinical yardstick measure while performing the Functional Reach test. RESULTS This study showed a low correlation (r = 0.38) between reach distance and displacement of centre of pressure and a moderate correlation (r = 0.68) between forward rotation of the trunk and reach distance. The movement during the Functional Reach test was characterized by a large forward rotation of the trunk and a small extension in the ankle. The latter constraining centre of pressure forward displacement. CONCLUSIONS The results suggest that the Functional Reach test is a weak measure of the stability limits. Movement of the trunk seems to influence the test more than the displacement of the centre of pressure. When using the Functional Reach test for assessing balance, compensatory mechanisms should be taken into account.

Epigenetic development of postural responses for sitting during infancy

This study examined whether postural responses emerge in children in a predetermined way before independent sitting is achieved, and in what respect postural responses in infants differ from those in adults. Children just able to sit independently and children not yet able to sit were exposed to surface perturbations (translation and rotation) while body movement and electromyographic (EMG) responses were recorded. Perturbations causing a backward sway of the body (i.e., forward translation and legs-up rotation), elicited consistent patterns of muscle activity in ventral hip, trunk, and neck muscles in the independently sitting children. A high tonic EMG background activity in trunk and neck extensor muscles was inhibited at the onset of the ventral muscle activity. Kinematic analysis revealed that backward rotation of the pelvis was the first detectable body movement, while head movements (linear and angular displacement) were irregular and occurred later than the pelvis movement. Perturbations in the opposite direction, causing a forward sway, evoked variable responses in dorsal trunk and neck muscles, suggesting that the excitability level for postural responses was set according to the stability limits of the body. Children not yet able to sit without support were tested when the support around the waist, given by the experimenters hands, was released prior to the onset of the platform perturbation. Postural responses were elicited in ventral muscles following a backward sway in all children and in about 60% of all trials. Often, only some of the ventral muscles were activated. No distinct responses were evoked during perturbations imposing a forward sway. These results suggest that (1) backward rotation of the pelvis triggers the postural adjustments in the independently sitting children; (2) a basic form of the postural adjustment develops in a predetermined manner before children practice independent sitting; and (3) the basic structure of ventral muscle activation pattern resembles that of adults, while the activation of the dorsal muscles (inhibition) differs in several aspects. These findings are in agreement with a recent model of central pattern generators for postural responses consisting of two operative levels. At the first level, which is triggered by backward rotation of the pelvis, the basic activation pattern is generated. At the second level, the pattern is shaped and fine-tuned by multisensory interactions from all activated sensory systems. The basic pattern present in the youngest infants may be produced mainly by neural networks at the first level, while the shaping function develops during practice, the shaping function being subjected to a learning process in which appropriate responses are formed in conjunction with the establishment of an internal neural representation for sitting.

DEFICITS IN RECIPROCAL INHIBITION OF CHILDREN WITH CEREBRAL PALSY AS REVEALED BY H REFLEX TESTING

Experiments were performed to determine whether spinal and supraspinal components of reciprocal inhibition (a neural mechanism responsible for the prevention of muscular co‐ordination during voluntary movement) were present in groups of non‐disabled children and children with cerebral palsy. Changes in the gastrocnemius‐soleus H reflex were examined during voluntary dorsiflexion and plantarflexion of the ankle and during a vibration applied to the anterior tibial tendon. The results indicate that children with cerebral palsy have impairments in reciprocal inhibition, both before and during voluntary movement. These deficits, which involve damage to supraspinal centres, contribute to their inability to perform smooth, co‐ordinated movements.

Myotatic reflex development in normal children and children with cerebral palsy

Neonatal neuronal exuberance and its retention following neonatal brain damage have been demonstrated in a number of species but not in humans. The purpose of the present ongoing study is to determine if there is any evidence of neonatal neuronal exuberance and its retention following damage to the CNS in the human. Of equal concern is the determination of the neurological mechanisms underlying abnormal movement and reflex development in children with cerebral palsy.

Anticipatory postural adjustments in a bimanual, whole-body lifting task seem not only aimed at minimising anterior–posterior centre of mass displacements

Anticipatory postural adjustments (APAs) were studied in a bimanual whole-body lifting task, using a mechanical analysis of the downward movement phase preceding loaded versus unloaded lifts. APAs in the backward ground reaction force were found to lead the perturbing forward box reaction with approximately 400 ms, thus inducing a backward centre of mass momentum. Both the APA onset and magnitude were scaled as a function of the load to be lifted. We conclude that, in this lifting task, the APAs served the generation of an appropriate extending moment of the ground reaction force after box pick-up, rather than the traditionally defined goal of minimising anterior-posterior centre of mass displacements.

Temporal coordination of the sit-to-walk task in subjects with stroke and in controls.

OBJECTIVES To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups. DESIGN Cross-sectional. SETTING Research laboratory. PARTICIPANTS A convenience sample of persons with hemiparesis (n=10; age 50-67y) more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs). RESULTS Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group. CONCLUSIONS The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses.

OBJECTIVE To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN Clinical experimental study. SUBJECTS Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.

Motor control of every day motor tasks: guidance for neurological rehabilitation.

This paper reports some of the research activities conducted at the Motor Control and Physical Therapy Laboratory aimed to understand the control of the coordination between posture and voluntary actions as reflected in the performance of everyday motor tasks in subject with normal and impaired motor control. Through multi-factorial analysis regarding the kinematics, ground reaction forces and muscle activity patterns (EMG), motor control variables critical for specific task performance are identified. Target-reaching in subjects after stroke and in children with cerebral palsy are discussed in some detail. Further, transfer skills in subjects with spinal cord injury as well as weight shift during gait initiation in young and elderly adults and during clinical balance testing are presented. The research findings are illuminated with respect to clinical implications in neurological rehabilitation, based on the motor control hypothesis.