Yi Chung Pai

CENTER OF MASS VELOCITY-POSITION PREDICTIONS FOR BALANCE CONTROL

The purposes of this analysis were to predict the feasible movements during which balance can be maintained, based on environmental (contact force), anatomical (foot geometry), and physiological (muscle strength) constraints, and to identify the role of each constraint in limiting movement. An inverted pendulum model with a foot segment was used with an optimization algorithm to determine the set of feasible center of mass (CM) velocity-position combinations for movement termination. The upper boundary of the resulting feasible region ran from a velocity of 1.1 s-1 (normalized to body height) at 2.4 foot lengths behind the heel, to 0.45 s-1 over the heel, to zero over the toe, and the lower boundary from a velocity of 0.9 s-1 at 2.7 foot lengths behind the heel, to zero over the heel. Forward falls would be initiated if states exceeded the upper boundary, and backward falls would be initiated if the states fell below the lower boundary. Under normal conditions, the constraint on the size of the base of support (BOS) determined the upper and lower boundaries of the feasible region. However, friction and strength did limit the feasible region when friction levels were less than 0.82, when dorsiflexion was reduced more than 51%, or when plantar flexion strength was reduced more than 35%. These findings expand the long-held concept that balance is based on CM position limits (i.e. the horizontal CM position has to be confined within the BOS to guarantee stable standing) to a concept based on CM velocity-position limits.

Dynamic transitions in stance support accompanying leg flexion movements in man

SummaryThe control processes underlying dynamic transitions in stance support during single leg flexion movements were investigated in human subjects as a function of the intended speed of movement, by examining the vertical and lateral horizontal components of the ground reaction forces, the frontal plane trajectory of the body center of mass (CM) recorded via motion analysis, and the electromyographic (EMG) recordings of selected lower limb muscles. For the slowest movements, the measured vertical force beneath the flexing and single stance limbs closely matched the vertical force-time history predicted by a quasi-static mechanical model, whereas, the more rapid natural and fast speeds showed progressively larger discrepancies between measured and predicted forces. The initial resultant horizontal force component was exerted in the flexing to stance limb direction but was proportionately greater (4∶1) beneath the flexing versus the stance limb during fast and natural speeds, and became equivalent for slow movements. Speed related EMG differences included an early phasic recruitment of the lateral hip muscle of the flexing limb which always preceded the ground reaction force changes for fast and natural but not slow movements, and a considerably earlier onset of the stance leg knee extensor relative to the flexing limb knee flexor for slow versus fast and natural speeds. Overall, the findings suggested two different speed related strategies for linking the postural and intentional movement components, where the choice of the strategy selected appeared to reflect the mechanical requirements needed to overcome the inertial force of the body mass during transitions from bipedal to single limb stance support.

Control of body mass transfer as a function of speed of ascent in sit-to-stand.

The purpose of this study was to test the hypothesis that a progressive variation in the speed of ascent would result in differences in the horizontal and vertical motions of the body center of mass (CM) and in the governing impulse-momentum relationship. A motion analysis system and two force platforms were used to examine the STS task among 10 healthy adults at each of three self-selected speeds. As the speed of ascent became faster, a progressively earlier time to the maximum vertical linear momentum and an increase in its magnitude occurred. In contrast, a relatively constant time to the maximum linear momentum, which was also the time when the propulsive impulse became the braking impulse, was found in the horizontal direction, and the propulsive impulse showed a disproportionately (1:3) smaller increase from slow to fast speeds than its vertical counterpart. The relative invariance in the horizontal motion suggested that different neuromuscular control strategies may have been employed in the horizontal and vertical directions to accomplish the different tasks of balance control in one direction and changing the gravitational potential energy in the other direction.

Feedforward adaptations are used to compensate for a potential loss of balance.

The central nervous system (CNS) must routinely compensate for unpredictable perturbations that occur during postural tasks. Such compensations could take the form of feedforward or feedback control. This study investigated whether the CNS, when faced with a potential postural perturbation, employs feedforward adjustments to reduce the near-term and overall likelihood of balance loss. Slips were induced, using bilateral low-friction platforms, during a sit-to-stand task in 60 safety-harnessed young adults. Subjects underwent a block of slipping trials, a block of nonslipping trials, then a mixed block of trials. After the first novel and unexpected slip, subjects were aware that a slip “may or may not occur.” The state (horizontal position and velocity) of the body center of mass (COM) at seat-off and the direction of balance loss (forward, no loss, backward) were determined for each trial. Feedforward adjustments were identified as between-trial changes in COM state at seat-off. Effects of these adjustments on the likelihood of balance loss were quantified using logistic regression. Results indicated that the likelihood of balance loss in each direction (forward, backward) under each condition (slipping, nonslipping) was significantly related to the COM state at seat-off. When faced with the potential perturbation, the CNS made near-term feedforward adjustments to reduce the likelihood of balance loss under the conditions last experienced; exposure to slipping and nonslipping conditions resulted in adjustments that reduced the likelihood of backward and forward balance losses, respectively. Subjects adapted their performance over the longer-term in a manner that significantly decreased their overall likelihood of balance loss in either direction under either condition. The CNS thus adapted to acquire an “optimal” movement strategy that reduced the reliance on reactive responses to maintain balance in an uncertain environment.

Speed variation and resultant joint torques during sit-to-stand

The purpose of this study was to test the hypothesis that a progressively faster speed of ascent requires significantly greater peak resultant joint torque (RJT) at major load-bearing joints of the lower limb during the sit-to-stand (STS) transfer. Eight healthy adults performed the STS at slow, natural, and fast speeds. A motion analysis system and two force platforms were employed to record kinetic data, and equations of motion were applied to compute the RJT for the ankle, knee, and hip. The results of the study supported the hypothesis that when the speed of ascent increased progressively, the peak hip flexion, knee extension, and ankle dorsiflexion RJTs increased disproportionately. However, the peak hip extension and ankle plantar flexion RJTs remained relatively constant across the range of the speeds. Implications for clinical practice pertaining to the timing and magnitude of RJT, as well as for interventions that emphasize the adaptive characteristics of movements, are suggested.

Impaired proprioception and osteoarthritis

The increase in the prevalence of osteoarthritis (OA) with age may be due in part to increased joint load resulting from age-related declines in neuromechanical factors, including joint position sense or proprioception. Several studies have demonstrated that knee proprioception is worse in knee OA patients versus age-matched control subjects. Functional consequences of impaired proprioception may include lower gait velocity, shorter stride length, and slower stair walking time. Some studies have shown that proprioception can be enhanced by wearing an elastic bandage or similar orthoses and by muscle training. A variety of other interventions have been proposed as well. To date studies of proprioception in OA patients have been cross-sectional. Theoretically, impaired proprioception might contribute toward or result from OA. A paradigm depicting directions in the relationship between proprioception impairment and OA is offered. Longitudinal data are badly needed to elucidate cause and effect and to determine the relative importance of impaired proprioception in disease progression. The relationship between sensory input and protective or damaging muscle activity has been minimally evaluated in the setting of OA. In studies of clinical conditions related to OA, experimental effusions had no effect on proprioception. Proprioception was worse in hypermobility syndrome patients versus age-matched controls. Anterior cruciate ligament insufficiency is associated with a decline in proprioception.

Thresholds for step initiation induced by support-surface translation: a dynamic center-of-mass model provides much better prediction than a static model

The need to initiate a step in order to recover balance could, in theory, be predicted by a static model based solely on displacement of the center of mass (COM) with respect to the base of support (BOS), or by a dynamic model based on the interaction between COM displacement and velocity. The purpose of this study was to determine whether the dynamic model provides better prediction than the static model regarding the need to step in response to moving-platform perturbation. The COM phase plane trajectories were determined for 10 healthy young adults for trials where the supporting platform was translated at three different acceleration levels in anterior and posterior directions. These trajectories were compared with the thresholds for step initiation predicted by the static and dynamic COM models. A single-link-plus-foot biomechanical model was employed to mathematically simulate termination of the COM movement, without stepping, using the measured platform acceleration as the input. An optimization routine was used to determine the stability boundaries in COM state space so as to establish the dynamic thresholds where a compensatory step must be initiated in order to recover balance. In the static model, the threshold for step initiation was reached if the COM was displaced beyond the BOS limits. The dynamic model showed substantially better accuracy than the static model in predicting the need to step in order to recover balance: 71% of all stepping responses predicted correctly by the dynamic model versus only 11% by the static model. These results support the proposition that the central nervous system must react to and control dynamic effects, i.e. COM velocity, as well as COM displacement in order to maintain stability with respect to the existing BOS without stepping.

Evaluation of a model that determines the stability limits of dynamic balance

A recent model of balance control has revealed two types of boundaries describing stability limits for center of mass (CM) dynamics: torque boundaries and state boundaries. The purpose of this study was to determine if these boundaries correctly characterize empirical data. We analyzed 2367 trials from 10 subjects who recovered their balance after they voluntarily pulled on a handle. We hypothesized that if model predictions were valid, both types of boundaries should encompass the empirical trajectories. We also hypothesized that each trajectorys nearest distance to the torque boundaries (the torque safety margin) would be correlated with the center of pressure (COP) safety margin, defined as the COPs nearest distance to the edge of the feet. The results supported the accuracy of the model-derived boundaries, with torque boundaries encompassing 100% and state boundaries encompassing 99.8% of the trials. Moreover, torque safety margins were highly correlated with COP safety margins, supporting the use of COP safety margins for estimating relative stability in dynamic tasks where balance is maintained. The distributions of the trajectories also suggested that a safety margin-oriented control strategy might be a robust alternative to the hypothesis that the central nervous system strives to optimize motion. The distinctions among different safety margins are discussed.

Does laxity alter the relationship between strength and physical function in knee osteoarthritis

OBJECTIVE Since strengthening interventions have had a lower-than-expected impact on patient function in studies of knee osteoarthritis (OA) and it is known that laxity influences muscle activity, this study examined whether the relationship between strength and function is weaker in the presence of laxity. METHODS One hundred sixty-four patients with knee OA were studied. Knee OA was defined by the presence of definite osteophytes, and patients had to have at least a little difficulty with knee-requiring activities. Tests were performed to determine quadriceps and hamstring strength, varus-valgus laxity, functional status (Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning subscale [WOMAC-PF] and chair-stand performance), body mass index, and pain. High and low laxity groups were defined as above and below the sample median, respectively. RESULTS Strength and chair-stand rates correlated (r = 0.44 to 0.52), as did strength and the WOMAC-PF score (r = -0.21 to -0.36). In multivariate analyses, greater laxity was consistently associated with a weaker relationship between strength (quadriceps or hamstring) and physical functioning (chair-stand rate or WOMAC-PF score). CONCLUSION Varus-valgus laxity is associated with a decrease in the magnitude of the relationship between strength and physical function in knee OA. In studies examining the functional and structural consequences of resistance exercise in knee OA, stratification of analyses by varus-valgus laxity should be considered. The effect of strengthening interventions in knee OA may be enhanced by consideration of the status of the passive restraint system.

The organization of torque and EMG activity during bilateral handle pulls by standing humans.

SummaryThis study examined whether the torques and EMG activity that precede and accompany bilateral arm pulls made by standing humans demonstrate a pulse height form of organization. Nine adults made abrupt bilateral pulls in the sagittal plane against a handle, to force targets equal to 5, 10, 20, 40, 60, 80 and 95% of their maximal pulling force (%MPF). The force applied at the handle, ground reaction forces, the center of pressure (CP), and EMG activity in gastrocnemius (GS), biceps femoris (BF), tibialis anterior (TA) and quadriceps (QD) muscles were recorded. Our analysis divided the action into a pre-pull phase (events prior to the increase of handle force) and a pulling phase (while handle force was greater than zero). We evaluated the effects of %MPF on the durations and peak amplitudes of the pre-pull and pulling angular impulses about the ankle joint and on pre-pull EMG patterns. The results showed that the angular impulse associated with the pulling torque (due to the reactive force on the body during the pull) had a pulse height organization: peak torque increased linearly with %MPF, and the durations of the pulling torque were relatively constant. In contrast, a pulse height organization did not characterize the pre-pull period for either the angular impulse associated with ankle torque (due to net ground reaction force) or EMG activity in the leg muscles. Rather, peak ankle torque typically increased up to some submaximal %MPF and then plateaued, perhaps due to a constraining effect of foot length on CP. The durations of pre-pull ankle torques increased over the whole range of %MPF, thereby compensating for the limit on ankle torque. Depending on the subject, the muscles were recruited in two different orders: GS-BF-TA-QD, or GS-TA-BF-QD. As the %MPF increased, the EMG onset times of all four muscles occurred earlier, and there was a greater likelihood that the BF, TA and QD muscles would be recruited on a given trial. The changes in the ankle torque and EMG patterns were gradual, suggesting that the pre-pull phase could have one underlying form of organization, with parameters that are tuned to task goals and anatomical constraints.