Michail Doumas

Brain Activity during Ankle Proprioceptive Stimulation Predicts Balance Performance in Young and Older Adults

Proprioceptive information from the foot/ankle provides important information regarding body sway for balance control, especially in situations where visual information is degraded or absent. Given known increases in catastrophic injury due to falls with older age, understanding the neural basis of proprioceptive processing for balance control is particularly important for older adults. In the present study, we linked neural activity in response to stimulation of key foot proprioceptors (i.e., muscle spindles) with balance ability across the lifespan. Twenty young and 20 older human adults underwent proprioceptive mapping; foot tendon vibration was compared with vibration of a nearby bone in an fMRI environment to determine regions of the brain that were active in response to muscle spindle stimulation. Several body sway metrics were also calculated for the same participants on an eyes-closed balance task. Based on regression analyses, multiple clusters of voxels were identified showing a significant relationship between muscle spindle stimulation-induced neural activity and maximum center of pressure excursion in the anterior–posterior direction. In this case, increased activation was associated with greater balance performance in parietal, frontal, and insular cortical areas, as well as structures within the basal ganglia. These correlated regions were age- and foot-stimulation side-independent and largely localized to right-sided areas of the brain thought to be involved in monitoring stimulus-driven shifts of attention. These findings support the notion that, beyond fundamental peripheral reflex mechanisms, central processing of proprioceptive signals from the foot is critical for balance control.

Task prioritization in aging: effects of sensory information on concurrent posture and memory performance

In older adults, cognitive resources play a key role in maintaining postural stability. In the present study, we evaluated whether increasing postural instability using sway referencing induces changes in resource allocation in dual-task performance leading older adults to prioritize the more age-salient posture task over a cognitive task. Young and older adults participated in the study which comprised two sessions. In the first session, three posture tasks (stable, sway reference visual, sway reference somatosensory) and a working memory task (n-back) were examined. In the second session, single- and dual-task performance of posture and memory were assessed. Postural stability improved with session. Participants were more unstable in the sway reference conditions, and pronounced age differences were observed in the somatosensory sway reference condition. In dual-task performance on the stable surface, older adults showed an almost 40% increase in instability compared to single-task. However, in the sway reference somatosensory condition, stability was the same in single- and dual-task performance, whereas pronounced (15%) costs emerged for cognition. These results show that during dual-tasking while standing on a stable surface, older adults have the flexibility to allow an increase in instability to accommodate cognitive task performance. However, when instability increases by means of compromising somatosensory information, levels of postural control are kept similar in single- and dual-task, by utilizing resources otherwise allocated to the cognitive task. This evidence emphasizes the flexible nature of resource allocation, developed over the life-span to compensate for age-related decline in sensorimotor and cognitive processing.

Timing and trajectory in rhythm production

The Wing-Kristofferson movement timing model (A. M. Wing & A. B. Kristofferson, 1973a, 1973b) distinguishes central timer and motor implementation processes. Previous studies have shown that increases in interresponse interval (IRI) variability with mean IRI are due to central timer processes, not motor implementation. The authors examine whether this is true with IRI duration changes in binary rhythm production. Ten participants provided IRI and movement data in bimanual synchronous tapping under equal (isochronous) and alternating (rhythm) interval conditions. Movement trajectory changes were observed with IRI duration (300, 500, or 833 ms) and for 500-ms IRIs produced in rhythm contexts (300/500 ms, 500/833 ms). However, application of the Wing-Kristofferson model showed that duration and context effects on IRI variability were attributable largely to timer processes with relatively little effect on motor processes.

White matter fractional anisotropy predicts balance performance in older adults.

Aging is characterized by brain structural changes that may compromise motor functions. In the context of postural control, white matter integrity is crucial for the efficient transfer of visual, proprioceptive and vestibular feedback in the brain. To determine the role of age-related white matter decline as a function of the sensory feedback necessary to correct posture, we acquired diffusion weighted images in young and old subjects. A force platform was used to measure changes in body posture under conditions of compromised proprioceptive and/or visual feedback. In the young group, no significant brain structure-balance relations were found. In the elderly however, the integrity of a cluster in the frontal forceps explained 21% of the variance in postural control when proprioceptive information was compromised. Additionally, when only the vestibular system supplied reliable information, the occipital forceps was the best predictor of balance performance (42%). Age-related white matter decline may thus be predictive of balance performance in the elderly when sensory systems start to degrade.

Combining multisensory temporal information for movement synchronisation

The ability to synchronise actions with environmental events is a fundamental skill supporting a variety of group activities. In such situations, multiple sensory cues are usually available for synchronisation, yet previous studies have suggested that auditory cues dominate those from other modalities. We examine the control of rhythmic action on the basis of auditory and haptic cues and show that performance is sensitive to both sources of information for synchronisation. Participants were required to tap the dominant hand index finger in synchrony with a metronome defined by periodic auditory tones, imposed movements of the non-dominant index finger, or both cues together. Synchronisation was least variable with the bimodal metronome as predicted by a maximum likelihood estimation (MLE) model. However, increases in timing variability of the auditory cue resulted in some departures from the MLE model. Our findings indicate the need for further investigation of the MLE account of the integration of multisensory signals in the temporal control of action.

Dual task performance of working memory and postural control in major depressive disorder

OBJECTIVE Previous studies with patients diagnosed with Major Depressive Disorder (MDD) revealed deficits in working memory and executive functions. In the present study we investigated whether patients with MDD have the ability to allocate cognitive resources in dual task performance of a highly challenging cognitive task (working memory) and a task that is seemingly automatic in nature (postural control). METHOD Fifteen young (18-35 years old) patients with MDD and 24 healthy age-matched controls performed a working memory task and two postural control tasks (standing on a stable or on a moving platform) both separately (single task) and concurrently (dual task). RESULTS Postural stability under single task conditions was similar in the two groups, and in line with earlier studies, MDD patients recalled fewer working memory items than controls. To equate working memory challenges for patients and controls, task difficulty (number of items presented) in dual task was individually adjusted such that accuracy of working memory performance was similar for the two groups under single task conditions. Patients showed greater postural instability in dual task performance on the stable platform, and more importantly when posture task difficulty increased (moving platform) they showed deficits in both working memory accuracy and postural stability compared with healthy controls. CONCLUSIONS We interpret our results as evidence for executive control deficits in MDD patients that affect their task coordination. In multitasking, these deficits affect not only cognitive but also sensorimotor task performance.

Postural Control Deficits in Autism Spectrum Disorder: The Role of Sensory Integration

We investigated the nature of sensory integration deficits in postural control of young adults with ASD. Postural control was assessed in a fixed environment, and in three environments in which sensory information about body sway from visual, proprioceptive or both channels was inaccurate. Furthermore, two levels of inaccurate information were used within each channel (gain 1 and 1.6). ASD participants showed greater postural sway when information from both channels was inaccurate. In addition, control participants’ ellipse area at gain 1.6 was identical to ASD participants’ at gain 1, reflecting hyper-reactivity in ASD. Our results provide evidence for hyper-reactivity in posture-related sensory information, which reflects a general, rather than channel-specific sensory integration impairment in ASD.

Leisure sports and postural control: can a black belt protect your balance from aging?

To determine potential benefits of intensive leisure sports for age-related changes in postural control, we tested 3 activity groups comprising 70 young (M = 21.67 years, SD = 2.80) and 73 older (M = 62.60 years, SD = 5.19) men. Activity groups were martial artists, who held at least 1st Dan (black belt), sportive individuals exercising sports without explicit balance components, and nonsportive controls. Martial artists had an advantage over sportive individuals in dynamic posture tasks (upright stance on a sway-referenced platform), and these 2 active groups showed better postural control than nonsportive participants. Age-related differences in postural control were larger in nonsportive men compared with the 2 active groups, who were similar in this respect. In contrast, negative age differences in other sensorimotor and cognitive functions did not differ between activity groups. We concluded that individuals engaging in intensive recreational sports have long-term advantages in postural control. However, even in older martial artists with years of practice in their sports, we observed considerable differences favoring the young.

Anodal Transcranial Direct Current Stimulation Shows Minimal, Measure-Specific Effects on Dynamic Postural Control in Young and Older Adults: A Double Blind, Sham-Controlled Study

We investigated whether stimulating the cerebellum and primary motor cortex (M1) using transcranial direct current stimulation (tDCS) could affect postural control in young and older adults. tDCS was employed using a double-blind, sham-controlled design, in which young (aged 18–35) and older adults (aged 65+) were assessed over three sessions, one for each stimulatory condition–M1, cerebellar and sham. The effect of tDCS on postural control was assessed using a sway-referencing paradigm, which induced platform rotations in proportion to the participant’s body sway, thus assessing sensory reweighting processes. Task difficulty was manipulated so that young adults experienced a support surface that was twice as compliant as that of older adults, in order to minimise baseline age differences in postural sway. Effects of tDCS on postural control were assessed during, immediately after and 30 minutes after tDCS. Additionally, the effect of tDCS on corticospinal excitability was measured by evaluating motor evoked potentials using transcranial magnetic stimulation immediately after and 30 minutes after tDCS. Minimal effects of tDCS on postural control were found in the eyes open condition only, and this was dependent on the measure assessed and age group. For young adults, stimulation had only offline effects, as cerebellar stimulation showed higher mean power frequency (MPF) of sway 30 minutes after stimulation. For older adults, both stimulation conditions delayed the increase in sway amplitude witnessed between blocks one and two until stimulation was no longer active. In conclusion, despite tDCS’ growing popularity, we would caution researchers to consider carefully the type of measures assessed and the groups targeted in tDCS studies of postural control.

The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review

Background: Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons’ quality of life (QoL). A large body of research explored the comorbidity between the two domains. Purpose: The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity. Data Collection and Analysis: PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, “Hearing loss,” hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults. Results: Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control. Conclusions: There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults.