Manh-Cuong Do

Are Dynamic Phenomena Prior to Stepping Essential to Walking

The aim of our research was to examine the function of the pre-gait weight shifts in generating the dynamic forces needed to start walking at different speeds. Five subjects participated in the experiment, and a total of 105 gait initiation movements, executed on a large force plate, for three speed conditions (slow, normal, and fast), were examined. Results, which related to durations of the anticipation and of the step execution phases and to biomechanical parameters (progression velocity of the center of gravity, backward shift of the center of foot pressure, and magnitude of propulsive forces at heel-off time), suggested that dynamic phenomena prior to stepping are essential to walking as far as they contribute to the creation of convenient conditions for progression. The configuration of the support basis prior to stepping limits the progression velocity reached at the end of the first step.

When and how does steady state gait movement induced from upright posture begin

The aim of this research was to study when and how the stationary process of gait begins when walking starts from upright posture. The subject initially stood up on a large force plate, then walked. Three conditions of speed (slow, normal, fast) were examined. Five subjects participated in the experiment. A total of 105 trials were performed. The results show that, at the end of the first step, the progression velocity of the center of gravity is not significantly different from the mean progression velocity of gait during the second step of gait and that the time necessary to reach steady state gait from initial posture phase is constant. Furthermore, the frequency of the first step, when compared to published values of the steady state gait frequency, is not significantly different from these frequencies. It can be concluded that the aim of the gait initiation process is to place the subject in steady-state gait within the first step, in an invariant time which is dependent only on the body segment parameters of each subject.

A biomechanical study of balance recovery during the fall forward

The study deals with the biomechanics of balance recovery of human subjects in a falling forward situation. Eight subjects took part in the experiment. The subject, held in the initial leaning forward position, was released without his knowledge. The instruction was to recover the induced disequilibrium by walking. The biomechanical analysis shows two phases in the balance recovery. The first phase--preparation phase--is characterized by three events at fixed timing whatever the initial inclination. (i) Dynamic reaction time, showing no significant inter-individual variation (mean value = 90.8 ms). (ii) Braking of the forward fall, between 184 ms and 237.2 ms, depending on the subject. (iii) Beginning of the swing phase--i.e. toe-off instant--between 235.9 ms and 328.3 ms, depending on the subject. The second phase--gait execution phase--is characterized by the duration of the swing phase, the duration of the stance phase, the stride length and execution speed. The durations diminish whereas the stride length and the execution speed increase with respect to the initial inclination. For the same execution speed, the stride length is shorter than in normal walking. It has been concluded that balance recovery following an induced fall forward begins with an invariable preparation process which is followed by an adaptable recovery one.

Influence of plantar cutaneous afferents on early compensatory reactions to forward fall

SummaryThe influence of cutaneous afferents in the compensatory reactions to a forward fall was investigated. Modification of cutaneous afferent activity was obtained in two different ways: first, by varying the initial pedal support conditions, secondly by anesthetizing the plantar foot sole. The initial pedal support conditions were: 1) bipedal posture, 2) unipedal posture, with contact and 3) unipedal posture, without contact. Nine healthy subjects participated in the control (without anesthesia) experimental session, of which three subjects participated in a session where the plantar sole was anesthetized. The compensatory reactions to a perturbation of balance of a subject initially with a bipedal stance, showed synchronized EMG activity in both Soleus muscles, starting on average at 59 ms, and a burst of EMG activity in the Tibialis Anterior of the starting foot after 200 ms. When the subject was in unipedal posture, the EMG responses on the side which was without support, showed several modifications: the EMG burst in Soleus was strikingly depressed, the response in Tibialis Anterior appeared earlier (mean latency 90 ms) and its magnitude was enhanced. When this foot was in contact with a rigid support, the Soleus showed a short burst of activity and the activity in Tibialis Anterior started at a mean latency of 150 ms. The results of the anesthesia session showed that: in the bipedal posture, the Soleus response was depressed and its duration shortened, the Tibialis Anterior response increased in magnitude and the onset was earlier; in the unipedal posture with contact, the magnitude of Soleus response was lower than the control value; in unipedal posture, the motor pattern was similar to that observed in the control unipedal condition. The plantar cutaneous afferents play a marked role in postural control regulation, as is evidenced by the comparison between the EMG responses in control situations and in sessions with anesthesia of the foot sole.

Changes in motor activity and biomechanics during balance recovery following cutaneous and muscular deafferentation.

The effects of lower limb deafferentation were examined during execution of a balance recovery step following a forward fall induced by release of an initial inclined posture. The subjects were healthy control subjects and patients with a unilateral loss of the Achilles tendon reflex following S1 radiculitis. Deafferentation of healthy subjects was obtained by unilateral leg ischemia (four subjects) and by foot anesthesia (five subjects). The balance recovery step was characterized by the surface electromyographic (EMG) activity of right and left soleus and tibialis anterior muscles and the kinetics of the center of gravity and center of foot pressure. Experimentally induced and pathological deafferentation decreased the EMG activity of the ipsilateral soleus and lowered the vertical ground reaction force. The lower limb motor activity was more affected by loss of muscle proprioceptive afferents than by loss of plantar cutaneous afferents. Patients showed early and bilateral changes in soleus and tibialis activities, whichever side was affected. The step length of patients was also shorter than that of controls, but it remained similar before and after deafferentation in the healthy subjects. The results are discussed in terms of ipsilateral and crossed pathway connections and functional adaptive strategies.

Do fast voluntary movements necessitate anticipatory postural adjustments even if equilibrium is unstable

Anticipatory postural adjustments (APA) were studied in maximum velocity flexion of lower limb from two initial postures, a bipedal stance (Fbu) and unipedal stance (Fuu). In Fbu, the dynamics of center of gravity (CG) and ankle and hip muscle EMG activity showed large APA. In contrast, in Fuu there were no APA, the CG dynamics and the ankle EMG activity started at the same time as the intentional movement while the hip EMG activity started some 30 ms before the thigh flexion. The knee flexion velocity was lower in Fuu than in Fbu (7 rd/s versus 12 rd/s). These results suggest that fast voluntary movements do not require APA when the postural equilibrium is unstable, and that an alternative strategy is used. The absence of APA in Fuu, in contrast to the presence of APA in Fbu, suggests that the postural command and the focal one are time-locked and organized in a parallel process.

Postural sway increase in low back pain subjects is not related to reduced spine range of motion

This study questioned whether postural sway increase in low back pain subjects was related to impaired spine mobility, and especially to a decrease in the range of motion, which was assumed to represent structural spine stiffness. Ten low back pain subjects and ten healthy control subjects performed spine flexion-extension and spine side bending tests, and standing posturographic examination in different experimental conditions. Low back pain subjects showed increased postural sway along the antero-posterior axis and reduced side bending, i.e. posturographic and range of motion parameters varied in the opposite direction. Moreover, no correlation was found between these two types of parameters. Although significant, the slight decrease in spine side bending did not seem sufficiently great to disturb the low amplitude movements that maintain postural equilibrium. Hence, it was concluded that postural sway increase in low back pain is not related to a reduced spine range of motion, but might be linked to an increase in muscular active tension, which reduces dynamic mobility capacity.

Gait and balance disorders in Parkinson's disease: impaired active braking of the fall of centre of gravity.

Gait and balance disorders are common in Parkinsons disease (PD), but its pathophysiology is still poorly understood. Step length, antero‐posterior, and vertical velocities of the center of gravity (CG) during gait initiation were analyzed in 32 controls and 32 PD patients, with and without levodopa, using a force platform. Brain volumes and mesencephalic surface area were measured in PD patients. During the swing limb period, controls showed a fall in the CG, which was reversed before foot‐contact indicating active braking of the CG fall. In PD patients, without levodopa, step length and velocity were significantly reduced and no braking occurred before foot‐contact in 22 patients. With levodopa, step length and velocity increased in all patients and 7 patients improved their braking capacity. PD patients with normal braking (n = 17) had significantly lower gait and balance disorder scores and higher normalized‐mesencephalic surface areas compared to patients with impaired braking (n = 15). The decreased step length and velocity, characteristic of PD, mainly result from degeneration of central dopaminergic systems. The markedly decreased braking capacity observed in half the PD patients contributes to their gait disorders and postural instability, perhaps as a result of nondopaminergic lesions, possibly at the mesencephalic level.

Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects

OBJECTIVE To determine whether body balance is perturbed more in low back pain patients than in healthy subjects, under the concept of posturo-kinetic capacity. DESIGN Comparison of posturographic and respiratory parameters between low back pain and healthy subjects. BACKGROUND It has been demonstrated that respiratory movements constitute a perturbation to posture, compensated by movements of the spine and of the hips, and that low back pain is frequently associated with a loss of back mobility. METHOD Ten low back pain patients and ten healthy subjects performed five posturographic tests under three different respiratory rate conditions: quiet breathing (spontaneous), slow breathing (0.1 Hz) and fast breathing (0.5 Hz). RESULTS Intergroup comparison showed that the mean displacements of the center of pressure were greater for the low back pain group, especially along the antero-posterior axis, where respiratory perturbation is primarily exerted. Inter-condition comparison showed that in slow and fast breathing relatively to quiet breathing, the mean displacement of the center of pressure along the antero-posterior axis was significantly increased only for the low back pain group. CONCLUSION According to the results, respiration presented a greater disturbing effect on body balance in low back pain subjects. RELEVANCE This study provides information on the causes of the impaired body balance associated with chronic low back pain, which could be used to improve treatment strategy.

Compensatory reactions in forward fall are they initiated by stretch receptors

Electromyographic activities from soleus and tibialis anterior muscles of 12 healthy subjects and 3 patients with vestibular syndrome, together with onset of movement of the head and leg were recorded during balance recovery. The disequilibrium was induced from initial forward inclination of the body. Soleus of the oscillatory foot showed brisk activity starting 59 msec (mean latency) after the perturbation and lasting 100-120 msec. Soleus of the stance foot showed similar activity, except that its duration was longer. The antagonist muscle activities started 5-20 msec later and showed similar time courses but of smaller amplitude. Ischaemia of the leg did not modify the latency. The onset of head movement was 10-20 msec after the perturbation, and those of leg were 70-90 msec. The results suggest that the early motor responses of the balance recovery were neither triggered by discharges from soleus group I and group II afferents, nor from vestibular cues, but could possibly originate in receptors located at the abdominal or lumbar level.