Posture and Locomotion Coupling: A Target for Rehabilitation Interventions in Persons with Parkinson's Disease

Disorders of posture, balance, and gait are debilitating motor manifestations of advancing Parkinson's disease requiring rehabilitation intervention. These problems often reflect difficulties with coupling or sequencing posture and locomotion during complex whole body movements linked with falls. Considerable progress has been made with demonstrating the effectiveness of exercise interventions for individuals with Parkinson's disease. However, gaps remain in the evidence base for specific interventions and the optimal content of exercise interventions. Using a conceptual theoretical framework and experimental findings, this perspective and review advances the viewpoint that rehabilitation interventions focused on separate or isolated components of posture, balance, or gait may limit the effectiveness of current clinical practices. It is argued that treatment effectiveness may be improved by directly targeting posture and locomotion coupling problems as causal factors contributing to balance and gait dysfunction. This approach may help advance current clinical practice and improve outcomes in rehabilitation for persons with Parkinson's disease

Sensorimotor reorganizations of arm kinematics and postural strategy for functional whole-body reaching movements in microgravity

International audienceIntegrative Physiology, a section of the journal Frontiers in Physiology Understanding the impact of weightlessness on human behavior during the forthcoming long-term space missions is of critical importance, especially when considering the efficiency of goal-directed movements in these unusual environments. Several studies provided a large set of evidence that gravity is taken into account during the planning stage of arm reaching movements to optimally anticipate its consequence upon the moving limbs. However, less is known about sensorimotor changes required to face weightless environments when individuals have to perform fast and accurate goal-directed actions with whole-body displacement. We thus aimed at characterizing kinematic features of whole-body reaching movements in microgravity, involving high spatiotemporal constraints of execution, to question whether and how humans are able to maintain the performance of a functional behavior in the standards of normogravity execution. Seven participants were asked to reach as fast and as accurately as possible visual targets while standing during microgravity episodes in parabolic flight. Small and large targets were presented either close or far from the participants (requiring, in the latter case, additional whole-body displacement). Results reported that participants successfully performed the reaching task with general temporal features of movement (e.g., movement speed) close to land observations. However, our analyses also demonstrated substantial kinematic changes related to the temporal structure of focal movement and the postural strategy to successfully perform-constrained-whole-body reaching movements in microgravity. These immediate reorganizations are likely achieved by rapidly taking into account the absence of gravity in motor preparation and execution (presumably from cues about body limbs unweighting). Specifically, when compared to normogravity, the arm deceleration phase substantially increased. Furthermore, greater whole-body forward displacements due to smaller trunk flexions occurred when reaching far targets in microgravity. Remarkably, these changes of focal kinematics and postural strategy appear close to those previously reported when participants performed the same task underwater with neutral buoyancy applied to body limbs. Overall, these novel findings reveal that humans are able to maintain the performance of functionalgoal-directed whole-body actions in weightlessness by successfully managing spatiotemporal constraints of execution in this unusual environment

Timing paradox of stepping and falls in ageing: not so quick and quick(er) on the trigger

Symposium on From TOP to TOE - What Falls Reveal about Physiological Ageing and Degeneration, Edinburgh, SCOTLAND, APR 10-11, 2015International audiencePhysiological and degenerative changes affecting human standing balance are major contributors to falls with ageing. During imbalance, stepping is a powerful protective action for preserving balance that may be voluntarily initiated in recognition of a balance threat, or be induced by an externally imposed mechanical or sensory perturbation. Paradoxically, with ageing and falls, initiation slowing of voluntary stepping is observed together with perturbation-induced steps that are triggered as fast as or faster than for younger adults. While age-associated changes in sensorimotor conduction, central neuronal processing and cognitive functions are linked to delayed voluntary stepping, alterations in the coupling of posture and locomotion may also prolong step triggering. It is less clear, however, how these factors may explain the accelerated triggering of induced stepping. We present a conceptual model that addresses this issue. For voluntary stepping, a disruption in the normal coupling between posture and locomotion may underlie step-triggering delays through suppression of the locomotion network based on an estimation of the evolving mechanical state conditions for stability. During induced stepping, accelerated step initiation may represent an event-triggering process whereby stepping is released according to the occurrence of a perturbation rather than to the specific sensorimotor information reflecting the evolving instability. In this case, errors in the parametric control of induced stepping and its effectiveness in stabilizing balance would be likely to occur. We further suggest that there is a residual adaptive capacity with ageing that could be exploited to improve paradoxical triggering and other changes in protective stepping to impact fall risk

Coordination posture / Equilibre / Mouvement (Rôle des informations sensorielles dans l'organisation des ajustements posturaux anticipés)

AIX-MARSEILLE2-BU Sci.Luminy (130552106) / SudocSudocFranceF

Postural dependence of human locomotion during gait initiation

International audienceThe initiation of human walking involves postural motor actions for body orientation and balance stabilization that must be effectively integrated with locomotion to allow safe and efficient transport. Our ability to coordinately adapt these functions to environmental or bodily changes through error-based motor learning is essential to effective performance. Predictive compensations for postural perturbations through anticipatory postural adjustments (APAs) that stabilize mediolateral (ML) standing balance normally precede and accompany stepping. The temporal sequencing between these events may involve neural processes that suppress stepping until the expected stability conditions are achieved. If so, then an unexpected perturbation that disrupts the ML APAs should delay locomotion. This study investigated how the central nervous system (CNS) adapts posture and locomotion to perturbations of ML standing balance. Healthy human adults initiated locomotion while a resistance force was applied at the pelvis to perturb posture. In experiment 1, using random perturbations, step onset timing was delayed relative to the APA onset indicating that locomotion was withheld until expected stability conditions occurred. Furthermore, stepping parameters were adapted with the APAs indicating that motor prediction of the consequences of the postural changes likely modified the step motor command. In experiment 2, repetitive postural perturbations induced sustained locomotor aftereffects in some parameters (i.e., step height), immediate but rapidly readapted aftereffects in others, or had no aftereffects. These results indicated both rapid but transient reactive adaptations in the posture and gait assembly and more durable practice-dependent changes suggesting feedforward adaptation of locomotion in response to the prevailing postural conditions

Stepping in Persons Poststroke: Comparison of Voluntary and Perturbation-Induced Responses

International audienceObjectives: To examine the stepping performance during voluntary and waist-pull perturbation-induced step initiation in people with chronic stroke. Design: Repeated-measures single-case design. Setting: University-based research laboratory. Participants: Community-dwelling stroke survivors (N=10). Interventions: Not applicable. Main Outcome Measures: Ground reaction forces and kinematic data were recorded to assess anticipatory postural adjustments (APAs) and step characteristics for both voluntary and induced stepping conditions. Results: Induced stepping was performed with both the paretic (35% trials) and nonparetic legs (65% trials). Induced first steps occurred earlier and were executed faster than rapid voluntary steps. Compared with voluntary stepping, induced first step APAs were shorter in duration. Step height was higher with the nonparetic leg for both stepping conditions. Use of the paretic leg increased (52%) during the diagonal perturbations that passively unloaded the stepping limb compared with the use of the paretic leg (33%) for forward perturbations. Conclusions: The results indicated differences in executing voluntary and induced stepping, and between the paretic and nonparetic limbs in individuals with chronic stroke. The findings suggested guidelines for using stepping as a component of neurorehabilitation programs for enhancing balance and mobility. Additional larger-scale studies remain to be undertaken to further investigate these issues. Archives of Physical Medicine and Rehabilitation 2013;94:2425-32 (C) 2013 by the American Congress of Rehabilitation Medicin

Age-dependent differences in lateral balance recovery through protective stepping." Clin Biomech

Abstract Background. Aging appears to present particular problems for lateral balance stability related to falls. Protective stepping is a common strategy for maintaining balance that may be impaired with aging due to changes in neuromusculoskeletal factors. This study assessed the response patterns, kinematics, and single support hip abduction torque during lateral protective stepping for balance recovery in healthy young and elderly adults. Methods. Ten healthy elderly and 10 younger adults received stepper-motor driven waist-pulls of bipedal stance applied pseudorandomly to either side. Stepping response strategies were quantified with force platforms and motion analysis. Findings. The young responded primarily using a single lateral sidestep with the limb that was initially loaded passively by the waist-pull, while older subjects favored crossover stepping using multiple steps with more inter-limb collisions. When the elderly did use loaded side steps, the steps were longer, slower, and higher and included greater and prolonged lateral trunk motion than in the young. Overall, older subjects produced greater and less rapid stabilizing hip abduction torque during the single support phase. Interpretation. Age-associated differences in lateral balance control through stepping included using a riskier recovery strategy with increased collisions between the limbs, multiple steps, altered first step characteristics and lateral trunk motion during direct sidestepping, and a generally greater support hip torque. The difficulties with lateral balance control in aging may reflect factors such as impaired hip abduction torque-time capacity and lateral trunk mobility/control. Our findings contribute additional knowledge pertaining to the problem of balance dysfunction and falls among the elderly

Perturbation-Induced Stepping Post-stroke: A Pilot Study Demonstrating Altered Strategies of Both Legs

International audienceIntroduction: Asymmetrical sensorimotor function after stroke creates unique challenges for bipedal tasks such as walking or perturbation-induced reactive stepping. Preference for initiating steps with the less-involved (preferred) leg after a perturbation has been reported with limited information on the stepping response of the more-involved (non-preferred) leg. Understanding the capacity of both legs to respond to a perturbation would enhance the design of future treatment approaches. This pilot study investigated the difference in perturbation-induced stepping between legs in stroke participant and non-impaired controls. We hypothesized that stepping performance will be different between groups as well as between legs for post-stroke participants