Marcos Duarte

Effects of body lean and visual information on the equilibrium maintenance during stance

Maintenance of equilibrium was tested in conditions when humans assume different leaning postures during upright standing. Subjects (n=11) stood in 13 different body postures specified by visual center of pressure (COP) targets within their base of support (BOS). Different types of visual information were tested: continuous presentation of visual target, no vision after target presentation, and with simultaneous visual feedback of the COP. The following variables were used to describe the equilibrium maintenance: the mean of the COP position, the area of the ellipse covering the COP sway, and the resultant median frequency of the power spectral density of the COP displacement. The variability of the COP displacement, quantified by the COP area variable, increased when subjects occupied leaning postures, irrespective of the kind of visual information provided. This variability also increased when vision was removed in relation to when vision was present. Without vision, drifts in the COP data were observed which were larger for COP targets farther away from the neutral position. When COP feedback was given in addition to the visual target, the postural control system did not control stance better than in the condition with only visual information. These results indicate that the visual information is used by the postural control system at both short and long time scales.

Postural assessment software (PAS/SAPO): validation and reliabiliy

OBJECTIVE: This study was designed to estimate the accuracy of the postural assessment software (PAS/SAPO) for measurement of corporal angles and distances as well as the inter- and intra-rater reliabilities. INTRODUCTION: Postural assessment software was developed as a subsidiary tool for postural assessment. It is easy to use and available in the public domain. Nonetheless, validation studies are lacking. METHODS: The study sample consisted of 88 pictures from 22 subjects, and each subject was assessed twice (1 week interval) by 5 blinded raters. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. To estimate the accuracy of the software, an inanimate object was marked with hallmarks using pre-established parameters. Pictures of the object were rated, and values were checked against the known parameters. RESULTS: Inter-rater reliability was excellent for 41% of the variables and very good for 35%. Ten percent of the variables had acceptable reliability, and 14% were defined as non-acceptable. For intra-rater reliability, 44.8% of the measurements were considered to be excellent, 23.5% were very good, 12.4% were acceptable and 19.3% were considered non-acceptable. Angular measurements had a mean error analisys of 0.11°, and the mean error analisys for distance was 1.8 mm. DISCUSSION: Unacceptable intraclass correlation coefficient values typically used the vertical line as a reference, and this may have increased the inaccuracy of the estimates. Increased accuracies were obtained by younger raters with more sophisticated computer skills, suggesting that past experience influenced results. CONCLUSION: The postural assessment software was accurate for measuring corporal angles and distances and should be considered as a reliable tool for postural assessment.

On the fractal properties of natural human standing.

We analyzed the temporal evolution of the displacement of the center of pressure (COP) during prolonged unconstrained standing (30 min) in non-impaired human subjects. The COP represents the collective outcome of the postural control system and the force of gravity and is the main parameter used in studies on postural control. Our analysis showed that the COP displacement during human standing displays fractal properties that were quantified by the Hurst exponent obtained from the classical rescaled adjusted range analysis. The average fractal or Hurst exponent (H) was 0.35+/-0.06. The presence of long-range correlations from a few seconds to several minutes due to the fractal characteristics of the postural control system has several important implications for the analysis of human balance.

Postural Sway during Dual Tasks in Young and Elderly Adults

Background: Previous studies have shown that healthy young adults are able to decrease their standing postural sway when an additional postural visual task, such as reading, is performed. Objective: In this study, we investigated postural sway during dual tasks in young and elderly adults. Methods: Twelve healthy active elderly adults (aged 65–75 years) and 12 healthy young adults (aged 22–39 years) participated in the study. The subjects performed different visual tasks while standing on a force plate. We varied the nature of the visual tasks (looking at a blank target versus a visual search task) and the distance of visual targets (near versus far). Center of pressure displacement obtained from the force plate data and kinematics of body segments obtained from a video analysis system were investigated. Results: Both groups presented significantly larger postural sway in the mediolateral direction during the eyes-closed condition as compared with the eyes-open condition. In the anteroposterior direction, this effect was observed only for the elderly group. Both groups had the same percentage correct in counting letters, but the elderly adults were significantly slower as compared with the young adults. The amplitude of postural sway was greater for the elderly adults than for the young adults in all conditions. However, both the young and the elderly adults exhibited significant reductions in sway during performance of the search task relative to sway during viewing of a blank target. The sway was also reduced for both groups during viewing a near target when compared to a distant target. Conclusions: The results suggest that, despite the overall increase in postural sway with aging, subtle integration of visual information by the postural control system is not affected by aging. The present results support the idea that dual tasks do not necessarily lead to an increase in postural sway. This effect, found here in elderly adults, raises questions about widely held views in which age-related changes in postural sway are related to competition between postural control and other activities for central processing resources.

Postural control during prolonged standing in persons with chronic low back pain

Prolonged standing has been associated with the onset of low back pain symptoms in working populations. So far, it is unknown how individuals with chronic low back pain (CLBP) behave during prolonged unconstrained standing (PS). The aim of the present study was to analyze the control of posture by subjects with CLBP during PS in comparison to matched healthy adults. The center of pressure (COP) position of 12 CLBP subjects and 12 matched healthy controls was recorded in prolonged standing (30min) and quiet stance tasks (60s) on a force plate. The number and amplitude of COP patterns, the root mean square (RMS), speed, and frequency of COP sway were analyzed. Statistical analyses showed that CLBP subjects produced less postural changes in the antero-posterior direction with decreased postural sway during the prolonged standing task in comparison to the healthy group. Only CLBP subjects were influenced by the prolonged standing task, as demonstrated by their increased COP RMS, COP speed and COP frequency in the quiet standing trial after the prolonged standing task in comparison to the pre-PS trial. The present study provides additional evidence that individuals with CLBP might have altered sensory-motor function. Their inability to generate responses similar to those of healthy subjects during prolonged standing may contribute to CLBP persistence or an increase risk of recurrent back pain episodes. Moreover, quantification of postural changes during prolonged standing could be useful to identify CLBP subjects prone to postural control deficits.

Quantitative Assessment of Postural Alignment in Young Adults Based on Photographs of Anterior, Posterior, and Lateral Views

OBJECTIVE Postural assessment through photography is a simple method that allows the acquisition of quantitative values to define the alignment of body segments. The purpose of this study was to quantitatively assess the postural alignment of several body segments in standing through anterior, posterior, and lateral views. METHODS In this cross-sectional study, 122 subjects were initially evaluated. Seven subjects were excluded from the study after cluster analysis. The final sample had 115 subjects, 75% women with a mean age of 26 ± 7 years. Photographs were taken from anterior, posterior, and lateral views after placement of markers on specific anatomical points. Photographs were analyzed using free Postural Analysis Software/Software of Postural Analysis (PAS/SAPO). Quantitative values for postural analysis variables were ascertained for head, upper and lower limbs, and trunk, along with the frequency of inclinations to the left and to the right. RESULTS Regarding the head, 88% of the sample presented some inclination, 67% of which was to the right. There was a predominance of right inclination of the shoulder and pelvis in 68% and 43% of study subjects, respectively. Lower limbs presented mean alignment of 178° in the anterior view, and the trunk showed predominant right inclination in 66% of participants. CONCLUSION Small asymmetries were observed in anterior and posterior views. This study suggests that there is no symmetry in postural alignment and that small asymmetries represent the normative standard for posture in standing.

Bouncing a ball: tuning into dynamic stability.

Rhythmically bouncing a ball with a racket was investigated and modeled with a nonlinear map. Model analyses provided a variable defining a dynamically stable solution that obviates computationally expensive corrections. Three experiments evaluated whether dynamic stability is optimized and what perceptual support is necessary for stable behavior. Two hypotheses were tested: (a) Performance is stable if racket acceleration is negative at impact, and (b) variability is lowest at an impact acceleration between -4 and -1 m/s2. In Experiment 1 participants performed the task, eyes open or closed, bouncing a ball confined to a 1-dimensional trajectory. Experiment 2 eliminated constraints on racket and ball trajectory. Experiment 3 excluded visual or haptic information. Movements were performed with negative racket accelerations in the range of highest stability. Performance with eyes closed was more variable, leaving acceleration unaffected. With haptic information, performance was more stable than with visual information alone.

Stabilographic analysis of unconstrained standing

Natural standing is characterized by postural changes and several hypotheses have been proposed to explain these changes. In this paper, four hypotheses were investigated by quantifying the number of postural changes in the centre of pressure data from unconstrained standing in different experimental conditions, studying the effects of mechanical loading, visual conditions, and type of support surface and sole of the shoes. The subjects stood for 30 min with no specific instructions other than not to step off a force plate. There were no significant effects on the number of centre of pressure patterns associated with the postural changes due to load, vision, surface and shoes during standing; on average, approximately two centre of pressure patterns per minute were observed in all conditions. The analysis of the centre of pressure data by the commonly used statistical parameters (standard deviation, velocity, and mean frequency of the centre of pressure displacement and area of the stabilogram) also did not reveal any effect of the different conditions.

Comparison of three-dimensional lower extremity running kinematics of young adult and elderly runners

Abstract The objective of this study was to compare the three-dimensional lower extremity running kinematics of young adult runners and elderly runners. Seventeen elderly adults (age 67–73 years) and 17 young adults (age 26–36 years) ran at 3.1 m · s−1 on a treadmill while the movements of the lower extremity during the stance phase were recorded at 120 Hz using three-dimensional video. The three-dimensional kinematics of the lower limb segments and of the ankle and knee joints were determined, and selected variables were calculated to describe the movement. Our results suggest that elderly runners have a different movement pattern of the lower extremity from that of young adults during the stance phase of running. Compared with the young adults, the elderly runners had a substantial decrease in stride length (1.97 vs. 2.23 m; P = 0.01), an increase in stride frequency (1.58 vs. 1.37 Hz; P = 0.002), less knee flexion/extension range of motion (26 vs. 33°; P = 0.002), less tibial internal/external rotation range of motion (9 vs. 12°; P < 0.001), larger external rotation angle of the foot segment (toe-out angle) at the heel strike (−5.8 vs. −1.0°; P = 0.009), and greater asynchronies between the ankle and knee movements during running. These results may help to explain why elderly individuals could be more susceptible to running-related injuries.

EFFECTS OF JOINT IMMOBILIZATION ON STANDING BALANCE

We investigated the effect of joint immobilization on the postural sway during quiet standing. We hypothesized that the center of pressure (COP), rambling, and trembling trajectories would be affected by joint immobilization. Ten young adults stood on a force plate during 60 s without and with immobilized joints (only knees constrained, CK; knees and hips, CH; and knees, hips, and trunk, CT), with their eyes open (OE) or closed (CE). The root mean square deviation (RMS, the standard deviation from the mean) and mean speed of COP, rambling, and trembling trajectories in the anterior-posterior and medial-lateral directions were analyzed. Similar effects of vision were observed for both directions: larger amplitudes for all variables were observed in the CE condition. In the anterior-posterior direction, postural sway increased only when the knees, hips, and trunk were immobilized. For the medial-lateral direction, the RMS and the mean speed of the COP, rambling, and trembling displacements decreased after immobilization of knees and hips and knees, hips, and trunk. These findings indicate that the single inverted pendulum model is unable to completely explain the processes involved in the control of the quiet upright stance in the anterior-posterior and medial-lateral directions.