Human Standing and Sitting Stability

Human Standing and Sitting Stability
Author: Alireza Noamani
Publisher:
Total Pages: 0
Release: 2022
Genre: Balances (Weighing instruments)
ISBN:

Falls are one of the most frequent causes of injury in the elderly and ambulatory individuals with neuromuscular impairments. Standing balance impairment is among the most consistent predictors of future falls. Furthermore, many individuals with neuromusculoskeletal conditions use a wheelchair for daily ambulation and often exhibit degraded trunk control during dynamic tasks, requiring assistance in seated stability. Therefore, implementing outcome measures that identify static balance difficulties may lead to more effective rehabilitation, and reduced future fall risk and fall severity in affected individuals. Characterizing the dynamic balance and neuromuscular control mechanisms are essential for identifying underlying impairments, implementing targeted rehabilitation, and developing assistive technologies. The overall goal of this thesis is to contribute toward developing methodologies for instrumented static and dynamic balance assessment with high sensitivity and responsiveness, allowing for a better understanding of the mechanisms of postural control. This thesis aimed to (1) develop and validate algorithms for reliable assessment of static balance using wearable technology, with the capability of being integrated into clinical tests for individuals with neuromuscular impairments; and (2) characterize the relationship between dynamic balance and risk of loss of balance and identify the roles of neuromuscular mechanisms involved in seated stability. First, we validated an algorithm for characterizing static balance using wearable technology against measurements of gold-standard in-lab equipment. We showed that our proposed method could provide accurate kinematics and kinetics measures and could be recommended for monitoring standing balance. Second, we used the validated algorithm to perform a static balance evaluation using wearable technology for ambulatory individuals with incomplete spinal cord injury (iSCI) with mild balance deficits during standing under various conditions. Our method enabled characterizing standing balance in this group compared to able-bodied participants with sufficient resolution and discriminatory ability for objective balance evaluation. Third, we used the validated algorithm to compare the postural control strategy between the same iSCI and able-bodied participants by characterizing their trunk-leg movement coordination under different sensory conditions. We observed trunk-leg movement coordination showed high sensitivity, discriminatory ability, and excellent test-retest reliability to identify changes in postural control strategy post-iSCI. Fourth, we investigated, in a clinical setting, the use of the validated algorithm above and the integration of wearable technology into a clinical scale test for objective outcome evaluation of balance rehabilitation in elderly with moderate-to-severe balance impairments. Our method enabled identifying and characterizing underlying causes of impaired balance pre- and post-rehabilitation with high sensitivity to subtle changes in balance. Fifth, we determined the limit of dynamic seated stability as a function of the trunk kinematics relative to the base of support. We experimentally validated the predicted limit of stability using traditional motion capture cameras. We then validated an algorithm to use wearable technology for assessing dynamic seated stability and risk of loss of balance against a gold-standard system. Sixth, we characterized the neuromuscular mechanisms involved in human sitting by identifying a nonlinear physiologically-meaningful neuromechanical model of seated stability. The model predicted the trunk sway behaviour during perturbed sitting with high accuracy. Our method accounted for physiological uncertainties while allowing for real-time tracking and correction of parameters' variations due to external disturbances and muscle fatigue. Seventh, we identified the high-level task goals of the neural control for regulating dynamic seated stability using nonlinear control theory. We observed the neural control might use trunk angular kinematics, primarily angular acceleration, as the input to achieve near-minimum muscle activation while keeping the deviations of the trunk angular position and acceleration sufficiently small. The practical outcome of this research toward static balance assessment is the development of algorithms used with wearable sensors for clinical objective balance assessment and characterization of complex balance mechanisms during static quiet stance. Such algorithms may provide a significant increase in the sensitivity of diagnosis of impaired balance for ambulatory individuals with iSCI with mild balance deficits and elderly with moderate-to-severe balance impairments. The practical outcomes of this research toward dynamic balance assessment are: (a) obtaining dynamic limits of stability for sitting; (b) the development of an algorithm for assessing the risk of loss of balance using wearable technology; (c) the development of a novel methodologies for a mechanistic understanding of the several neuromuscular stabilization mechanisms and high-level task goals of the neural control for maintaining dynamic stability.

Quantifying the Effect of Visual and Support Surface Oscillations on the Orthogonality of Balance Control During Gait

Quantifying the Effect of Visual and Support Surface Oscillations on the Orthogonality of Balance Control During Gait
Author: Kyle Brozek
Publisher:
Total Pages: 0
Release: 2020
Genre: Equilibrium (Physiology)
ISBN:

Previous gait research has shown that ratio of anteroposterior (AP) and mediolateral (ML) step width variability reversed when the direction of progression changed from forward to sideways walking. Unfortunately, the study did not quantify the nature of this reversal over a range of progression angles. Additional research has shown visual perturbations during otherwise normal walking (Wurdeman et al. 2012; O'Connor & Kuo 2009). Therefore, our main research aim is to determine the contribution of both visual and proprioceptive feedback on the orthogonal relationship between gait and balance control during a range of conditions. Seventeen participants were subjected to seven conditions as they walked on a treadmill as the support surface, virtual reality optic flow, or both, oscillated in the transverse plane. Step length and step width variability provided the gait variability measures while variability in balance control was determined by calculating the variability of the center of mass (CoM) range of motion. The ML variability of the CoM was significantly higher during all oscillatory conditions compared to baseline. This supports reported comments from subjects who stated that it was hardest to maintain balance during walking in the oscillatory conditions, specifically the congruent condition more than any other. Subjects displayed the greatest variability increases when walking in an environment where the support surface and VR environment were providing matched, oscillating signals. When visual and proprioceptive signals are separated by a phase shift or if one of the signals is providing consistent information, it appears to be easier for subjects to maintain balance. Our results provide insight into how visual feedback while walking on a stable or unstable support surface affects gait and balance control during locomotion. Additionally, our results provide insight into how the orthogonality of gait and balance changes as the oscillation angle increases. This may have applications in the field of sensory feedback-based rehabilitation protocols.

Gait Disorders of Aging

Gait Disorders of Aging
Author: Joseph C. Masdeu
Publisher: Little, Brown Medical Division
Total Pages: 443
Release: 1997
Genre: Medical
ISBN: 9780316549158

Gait and balance disorders are common in the elderly and an important source of morbidity. They contribute in a measurable way to the risk for falls and fall-related injury. These disorders are essentially an interdisciplinary problem. Neurology, neurophysiology, rehabilitation medicine, orthopedics, and geriatrics all have different approaches to problems of mobility in the elderly. The authors have produced a book which will be useful and accessible to practitioners in all of these disciplines. The book includes epidemiology, sections on methods, treatment and approaches to rehabilitation, some discussion of normal physiology, and a review of diseases which contribute to gait and balance disorders.

Quantification of the Human Postural Control System to Perturbations

Quantification of the Human Postural Control System to Perturbations
Author: Pilwon Hur
Publisher:
Total Pages:
Release: 2011
Genre:
ISBN:

Human standing posture is inherently unstable. The postural control system (PCS), which maintains standing posture, is composed of the sensory, musculoskeletal, and central nervous systems. Together these systems integrate sensory afferents and generate appropriate motor efferents to adjust posture. The PCS maintains the body center of mass (COM) with respect to the base of support while constantly resisting destabilizing forces from internal and external perturbations. To assess the human PCS, postural sway during quiet standing or in response to external perturbation have frequently been examined descriptively. Minimal work has been done to understand and quantify the robustness of the PCS to perturbations. Further, there have been some previous attempts to assess the dynamical systems aspects of the PCS or time evolutionary properties of postural sway. However those techniques can only provide summary information about the PCS characteristics; they cannot provide specific information about or recreate the actual sway behavior. This dissertation consists of two parts: part I, the development of two novel methods to assess the human PCS and, part II, the application of these methods. In study 1, a systematic method for analyzing the human PCS during perturbed stance was developed. A mild impulsive perturbation that subjects can easily experience in their daily lives was used. A measure of robustness of the PCS, 1/MaxSens that was based on the inverse of the sensitivity of the system, was introduced. 1/MaxSens successfully quantified the reduced robustness to external perturbations due to age-related degradation of the PCS. In study 2, a stochastic model was used to better understand the human PCS in terms of dynamical systems aspect. This methodology also has the advantage over previous methods in that the sway behavior is captured in a model that can be used to recreate the random oscillatory properties of the PCS. The invariant density which describes the long-term stationary behavior of the center of pressure (COP) was computed from a Markov chain model that was applied to postural sway data during quiet stance. In order to validate the Invariant Density Analysis (IDA), we applied the technique to COP data from different age groups. We found that older adults swayed farther from the centroid and in more stochastic and random manner than young adults. In part II, the tools developed in part I were applied to both occupational and clinical situations. In study 3, 1/MaxSens and IDA were applied to a population of firefighters to investigate the effects of air bottle configuration (weight and size) and vision on the postural stability of firefighters. We found that both air bottle weight and loss of vision, but not size of air bottle, significantly decreased balance performance and increased fall risk. In study 4, IDA was applied to data collected on 444 community-dwelling elderly adults from the MOBILIZE Boston Study. Four out of five IDA parameters were able to successfully differentiate recurrent fallers from non-fallers, while only five out of 30 more common descriptive and stochastic COP measures could distinguish the two groups. Fall history and the IDA parameter of entropy were found to be significant risk factors for falls. This research proposed a new measure for the PCS robustness (1/MaxSens) and a new technique for quantifying the dynamical systems aspect of the PCS (IDA). These new PCS analysis techniques provide easy and effective ways to assess the PCS in occupational and clinical environments.

The Contribution of Postural Adjustments to Body Balance and Motor Performance

The Contribution of Postural Adjustments to Body Balance and Motor Performance
Author: Eric Yiou
Publisher: Frontiers Media SA
Total Pages: 417
Release: 2019-02-08
Genre:
ISBN: 2889457524

The control of balance by the central nervous system is crucial to maintain our posture and perform efficiently our daily motor tasks. This control requires the development of dynamical phenomena sub-served by highly-coordinated patterns of muscle activation/deactivation disseminated throughout the whole-body and called “postural adjustments”. Establishing the interaction between balance control, locomotion and cognition has important clinical implication, especially in term of falls prevention, and will improve our knowledge on the underlying neural correlates. This Research Topic provides an up-to-date picture of the relationship between postural adjustments, body balance and motor performance in healthy (young and older adults) and pathological participants. It includes 36 contributions (1 editorial, 28 original articles, 4 reviews and 3 methods articles) which are separated into four sections: 1. Postural maintenance and multisensory integration, 2. Anticipatory postural adjustments associated with voluntary movement, 3. Postural adjustments associated with predictable and unpredictable external perturbation, 4. Gait assessment and rehabilitation in aging. Beside their basic interest of unveiling the mechanisms behind motor control, results from the investigations of this topic are relevant to develop new methods or tools to improve postural stability and motor performance, with applications in the fields of neurodegenerative conditions, rehabilitation, ergonomics and sports sciences.

Balance Dysfunction in Parkinson's Disease

Balance Dysfunction in Parkinson's Disease
Author: Martina Mancini
Publisher: Academic Press
Total Pages: 228
Release: 2019-09-14
Genre: Medical
ISBN: 0128138750

Balance Dysfunction in Parkinson's Disease: Basic Mechanisms to Clinical Management presents the most updated information on a variety of topics. Sections help clinicians evaluate the types of balance control issues, dynamic balance dysfunction during turning, and the effects of medication, deep brain stimulation, and rehabilitation intervention on balance control. This book is the first to review the four main postural control systems and how they are affected, including balance during quiet stance, reactive postural adjustments to external perturbations, anticipatory postural adjustments in preparation for voluntary movements, and dynamic balance control during walking and turning. In addition, the book's authors summarize the effects of levodopa, deep brain stimulation, and rehabilitation intervention for each balance domain. This book is recommended for anyone interested in how and why balance control is affected by PD. - Provides the first comprehensive review of research to date on balance dysfunctions in Parkinson's disease - Discusses how to translate current neuroscience research into practice regarding neural control of balance - Provides evidence on the effects of current interventions on balance control

Sensory Integration for Postural Control During Stance on Compliant Surfaces

Sensory Integration for Postural Control During Stance on Compliant Surfaces
Author: Anat Lubetzky-Vilnai
Publisher:
Total Pages: 88
Release: 2014
Genre:
ISBN:

Both Sides Up (BOSU) balls are often used in sports rehabilitation as a form of `somatosensory training'. Memory foam is often used in neurologic rehabilitation as a method of disrupting the somatosensory systems' contributions to balance in order to enhance dependence on vision and vestibular input. The purposes of this study were to quantify how much young adults depended on vision (via response to moving dots projected on a screen) and on somatosensory cues (via their response to bilateral brief Achilles tendon vibration) when standing on different surfaces. The responses of 30 healthy young adults (HEALTHY) were compared to the responses of 10 young adults with history of repeated ankle sprains (SPRAIN) when participants were standing on a firm surface, memory foam and a BOSU ball. The primary measures of visual dependence were: the ratio of body-sway amplitude at the visual frequency over all other sway peaks (Visual Amplitude Fraction [VAF]), and the estimated frequency of the peak of body-sway (EFP) amplitude. To quantify response to vibration we used traditional (Center of Pressure excursion) and nonlinear measures (Complexity Index). In both groups, VAFs were significantly higher on the BOSU compared to floor or foam (P