A Modified Lean and Release Technique to Emphasize Response Inhibition and Action Selection in Reactive Balance

Assessment of reactive balance traditionally imposes some type of perturbation to upright stance or gait followed by measurement of the resultant corrective behavior. These measures include muscle responses, limb movements, ground reaction forces, and even direct neurophysiological measures such as electroencephalography. Using this approach, researchers and clinicians can infer some basic principles regarding how the nervous system controls balance to avoid a fall. One limitation with the way in which these assessments are currently used is that they heavily emphasize reflexive actions without any need to revise automatic postural reactions. Such an exclusive focus on these highly stereotypical reactions would fail to adequately address how we can modify these reactions should the need arise (e.g., avoiding an obstacle with a recovery step). This would appear to be a glaring omission when one considers the enormous complexity of the environments we face daily. Overall, the status quo when evaluating the neural control of balance fails to truly expose how higher brain resources contribute to preventing falls in complex settings. The present protocol offers a way to require suppression of automatic, but inappropriate corrective balance reactions, and force a selection among alternative action choices to successfully recover balance following postural perturbation

Motor Affordance for Grasping a Safety Handle

Mere observation of objects in our surroundings can potentiate movement, a fact reflected by visually-primed activation of motor cortical networks. This mechanism holds potential value for reactive balance control where recovery actions of the arms or legs must be targeted to a new support base to avoid a fall. The present study was conducted to test if viewing a wall-mounted safety handle – the type of handle commonly used to regain balance – results in activation of motor cortical networks. We hypothesized that the hand area of the primary motor cortex would be facilitated shortly after visual access to a safety handle versus when no handle was visible. Here, we used transcranial magnetic stimulation (TMS) to measure corticospinal excitability in hand muscles directly following access to vision while participants performed a seated reach-grasp task. Vision was controlled using liquid crystal lenses and TMS pulses were time-locked to occur shortly after the goggles opened but prior to any cue for movement. Between trials the response environment was unpredictably altered to present either a handle or no handle (i.e. covered). Our results demonstrated a rapid motor facilitation in muscles of the right hand when participants viewed a handle versus trials where this handle was covered. This effect was selective both in terms of the muscles activated and the timing at which it emerged. The First Dorsal Interosseus and Opponens Pollicus muscles (synergists in closing the hand) were facilitated 120 ms after viewing the handle. Interestingly, this effect was absent at earlier (80 ms) and later (160 ms) points. Conversely, Abductor Digiti Minimi, which moves the little finger out from the rest of the hand, tended to diminish when viewing the handle. These findings suggest a rapid engagement of muscles suitable for grasping a handle based on vision. This is consistent with the concept of affordances where vision automatically translates viewed objects into appropriate motor terms. The fact that this affordance effect was present for a wall-mounted safety handle commonly used to regain balance has implications for automatically priming recovery actions with upper limbs suited to our surroundings, even before postural perturbation is detected

Stop-Signal Reaction Time Correlates With a Compensatory Balance Response

Background Response inhibition involves suppressing automatic, but unwanted action, which allows for behavioral flexibility. This capacity could theoretically contribute to fall prevention, especially in the cluttered environments we face daily. Although much has been learned from cognitive psychology regarding response inhibition, it is unclear if such findings translate to the intensified challenge of coordinating balance recovery reactions. Research question Is the ability to stop a prepotent response preserved when comparing performance on a standard test of response inhibition versus a reactive balance test where compensatory steps must be occasionally suppressed? Methods Twelve young adults completed a stop signal task and reactive balance test separately. The stop signal task evaluates an individual’s ability to quickly suppress a visually-cued button press upon hearing a ‘stop’ tone, and provides a measure of the speed of response inhibition called the Stop Signal Reaction Time (SSRT). Reactive balance was tested by releasing participants from a supported lean position, in situations where the environment was changed during visual occlusion. Upon receiving vision, participants were required to either step to regain balance following cable release (70% of trials), or suppress a step if an obstacle was present (30% of trials). The early muscle response of the stepping leg was compared between the ‘step blocked’ and ‘step allowed’ trials to quantify step suppression. Results SSRT was correlated with muscle activation of the stepping leg when sufficient time was provided to view the response environment (400 ms). Individuals with faster SSRTs exhibited comparably less leg muscle activity when a step was blocked, signifying a superior ability to inhibit an unwanted step. Significance Performance on a standardized test of response inhibition is related to performance on a reactive balance test where automated stepping responses must occasionally be inhibited. This highlights a generalizable neural mechanism for stopping action across different behavioral contexts

Reaction Times Altered by Anterior Cruciate Ligament Tear

The anterior cruciate ligament (ACL) tear is associated with declined performance upon return to sport, with high rates of reinjury. Despite ACL reconstruction, ACL tears induce neuroplasticity, increasing reliance on vision and preparation time in movement. This increased reliance on vision and time could lead to motor control strategy deficits under sport-specific tasks. PURPOSE: To determine if ACL injury results in slower muscle onsets in a reactive stepping task and if this is affected by preparation. METHODS: Reactive balance was assessed in ACL (N=6) and healthy control (CON; N=12) participants using a lean and release device to initiate a temporally unpredictable perturbation to prompt reactions by taking a right or left step dictated via leg blocks. 75% of the time, a predetermined right or left step was taken more often (i.e., frequent step; FS) to create unpredictability. The FS leg was counterbalanced midway through testing. Prior to a perturbation, participants viewed the leg blocks move (proactive; P), or were given 400ms of vision prior to release (reactive; R). Muscle onsets were measured by electromyography sensors. Two separate two-way ANOVAs with Bonferroni post-hoc analyses (p ≤ 0.05) assessed differences in muscle onset between each leg (dominant, nondominant), across groups (CON, ACL), and by preparation time (P, R). RESULTS: The FS reaction was consistently faster (p \u3c 0.05). The ANOVA results had main effects for legs (p \u3c 0.05), and groups (p \u3c 0.05). When the infrequent step was taken, significance was evident, but Bonferroni post-hoc analyses showed significance only in the CON group, where dominant legs (104 ± 55 ms) were faster than nondominant legs (171 ± 50 ms; p \u3c .0001), but not in the ACLR group between uninjured legs (78 ± 36 ms), and injured legs (113 ± 39 ms) (p = 0.2277). There was no significance when comparing preparation time between groups. CONCLUSION: Regardless of condition, the FS was consistently faster, but the ACLR group showed a decreased ability to slow muscle onset when asked to stop action in the FS to initiate the infrequent step. Yet, there is no significant difference between groups regardless of the preparation time given. Such results suggest an impaired motor control strategy after ACL injury, but muscle onset may not be a sensitive enough measure to definitively conclude

Priming of Grasping Muscles When Viewing a Safety Handle is Diminished With Age

Merely viewing objects within reachable space can activate motor cortical networks and potentiate movement. This holds potential value for smooth interaction with objects in our surroundings, and could offer an advantage for quickly generating targeted hand movements (e.g. grasping a support rail to maintain stability). The present study investigated if viewing a wall-mounted safety handle resulted in automatic activation of motor cortical networks, and if this effect changes with age. Twenty-five young adults (18–30 years) and seventeen older adults (65+ years) were included in this study. Single-pulse, transcranial magnetic stimulation was applied over the motor cortical hand representation of young and older adults shortly after they viewed a safety handle within reaching distance. Between trials, vision was occluded and the environment was unpredictably altered to reveal either a safety handle, or no handle (i.e. covered). Modulation of intrinsic hand muscle activity was evident in young adults when viewing a handle, and this was selective in terms of both the muscles activated and the time at which it emerged. By contrast, older adults failed to show any changes when viewing the safety handle. Specifically, the presence of a handle increased corticospinal activity in hand muscles of young adults when TMS was applied 120 ms after opening the goggles (p = .014), but not in the older adults (p \u3e .954). The fact that the visual priming observed in younger adults was absent in older adults suggests that aging may diminish the ability to quickly put our visual world into automatic motor terms

Aligning the CMS Muon Chambers with the Muon Alignment System during an Extended Cosmic Ray Run

Peer reviewe

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Forecast or Fall: Prediction\u27s Importance to Postural Control

To interact successfully with an uncertain environment, organisms must be able to respond to both unanticipated and anticipated events. For unanticipated events, organisms have evolved stereotyped motor behaviors mapped to the statistical regularities of the environment, which can be trigged by specific sensory stimuli. These \u27reflexive\u27 responses are more or less hardwired to prevent falls and represent, maybe, the best available solution to maintaining posture given limited available time and information. With the gift of foresight, however, motor behaviors can be tuned or prepared in advance, improving the ability of the organism to compensate for, and interact with, the changing environment. Indeed, foresight\u27s improvement of our interactive capacity occurs through several means, such as better action selection, processing and conduction delay compensation and by providing a prediction with which to compare our actual behaviors to, thereby facilitating error identification and learning. Here we review the various roles foresight (prediction) plays in maintaining our postural equilibrium. We start by describing some of the more recent findings related to the prediction of instability. Specifically, we cover recent advancements in the understanding of anticipatory postural behaviors that are used broadly to stabilize volitional movement and compensate for impending postural disturbances. We also describe anticipatory changes in the state, or set, of the nervous system that may facilitate anticipatory behaviors. From changes in central set, we briefly discuss prediction of postural instability online before moving into a discussion of how predictive mechanisms, such as internal models, permit us to tune, perhaps our highest level predictive behaviors, namely the priming associated with motor affordances. Lastly, we explore methods best suited to expose the contribution of prediction to postural equilibrium control across a variety of contexts

The role of the cerebral cortex in postural responses to externally induced perturbations

The ease with which we avoid falling down belies a highly sophisticated and distributed neural network for controlling reactions to maintain upright balance. Although historically these reactions were considered within the sub cortical domain, mounting evidence reveals a distributed network for postural control including a potentially important role for the cerebral cortex. Support for this cortical role comes from direct measurement associated with moments of induced instability as well as indirect links between cognitive task performance and balance recovery. The cerebral cortex appears to be directly involved in the control of rapid balance reactions but also setting the central nervous system in advance to optimize balance recovery reactions even when a future threat to stability is unexpected. In this review the growing body of evidence that now firmly supports a cortical role in the postural responses to externally induced perturbations is presented. Moreover, an updated framework is advanced to help understand how cortical contributions may influence our resistance to falls and on what timescale. The implications for future studies into the neural control of balance are discussed