An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information

In the present experiments, multiple balance perturbations were provided by unpredictable support-surface translations in various directions and velocities. The aim of this study was to distinguish the passive and the active phases during the pre-impact period of a fall. It was hypothesized that it should be feasible if one uses a specific quantitative kinematic analysis to evaluate the dispersion of the body segments trajectories across trials. Moreover, a multi-joint kinematical model was created for each subject, based on a new 3-D minimally invasive stereoradiographic X-ray images to assess subject-specific geometry and inertial parameters. The simulations allowed discriminating between the contributions of the passive (inertia-induced properties) and the active (neuromuscular response) components during falls. Our data show that there is limited time to adjust the way one fall from a standing position. We showed that the pre-impact period is truncated of 200 ms. During the initial part of a fall, the observed trajectory results from the interaction between the destabilizing external force and the body: inertial properties intrinsic to joints, ligaments and musculotendinous system have then a major contribution, as suggested for the regulation of static upright stance. This passive phase is later followed by an active phase, which consists of a corrective response to the postural perturbation. We believe that during a fall from standing height, it takes about 300 ms for postural responses to start correcting the body trajectory, while the impact is expected to occur around 700 ms. It has been argued that this time is sufficient to change the way one falls and that this makes it possible to apply safer ways of falling, for example by using martial arts fall techniques. Also, our results imply visual and vestibular information are not congruent with the beginning of the on-going fall. This consequence is to be noted as subjects prepare to the impact on the basis of sensory information, which would be uniquely mainly of proprioceptive origin at the fall onset. One limitation of the present analysis is that no EMG was included so far but these data are the subject of a future study

Etude du contrôle postural chez l'homme (analyse des facteurs neurophysiologiques, biomécaniques et cognitifs, impliqués dans les 500 premières millisecondes d'une chute)

La chute chez les seniors constitue un problème de santé publique. Citée comme la seconde cause de décès accidentel dans le monde, elle concerne un tiers des Français de plus de 65 ans. Les séquelles physiques et fonctionnelles qui en résultent, les conséquences psychosociales nuisibles pour la qualité de la vie, la perte d autonomie et son coût de prise en charge justifient l attention qui lui est actuellement portée. Du point de vue du chercheur, les interprétations sous-jacentes à la surexposition des personnes âgées au risque de chute restent controversées, notamment parce que la compréhension de la coordination dynamique corporelle et de l implication corticale lors du contrôle de l équilibre est encore limitée. L étude de la chute et des mécanismes qui y conduisent présente donc un double intérêt, fondamental et sociétal. Une chute survient si deux conditions sont réunies. La première est la perte initiale de l équilibre, un pré-requis qui peut toucher la population entière dans son quotidien. La seconde est un échec des mécanismes de rééquilibration, c est à dire de la stratégie de réponse mise en œuvre pour compenser la déstabilisation : comment s opère la sélection d une stratégie de rattrapage, à partir de quelle appréciation du contexte et des informations sensorielles disponibles est-elle choisie ? qu est ce qui assure son opérationnalité et garantit le rattrapage ou signe au contraire son échec ?...Pour répondre à ces questions, nous nous sommes donc intéressés à ce moment critique où il est encore possible de modifier l issue finale par des ajustements posturaux et des actions motrices rapides et adéquats chez une population de jeunes adultes. La première étude est une analyse globale de la phase précoce d une chute -abrégée par un harnais- (soit quelques centaines de millisecondes après la perturbation), afin d évaluer la capacité du sujet à réagir à une perturbation imprévue et de développer des stratégies garantissant une protection efficace. Cette première étape se propose d identifier les indicateurs discriminants et prédictifs d une chute et d un rattrapage au niveau neurophysiologique et biomécanique. Cette étude a également permis de mettre en évidence la présence d un délai temporel incompressible appelé phase passive , source de contraintes spatio-temporelles à l expression complète d une réponse posturale adaptée. Dans la seconde étude, de modélisation, nous avons élaboré un modèle mécanique personnalisé, construit à partir de radiographies tridimensionnelles non invasives du corps entier. Cette modélisation nous a permis d analyser la contribution relative de propriétés biomécaniques passives et des synergies musculaires actives en jeu pendant les perturbations récupérables de l équilibre ou non en comparant les résultats expérimentaux ( réels ) obtenus à l aide d un dispositif asservi pour provoquer des chutes de plain-pied et la réponse théorique prédite ( simulée ) à l aide du modèle. Les résultats obtenus permettent de confirmer que le comportement du corps est en phase précoce-dicté par ses propriétés mécaniques, et peut être assimilé à un modèle simplifié. Après avoir mis en évidence l existence d une phase inertielle d une durée équivalente à la moitié du temps disponible avant l impact, notre questionnement s est orienté vers le traitement de l information en-cours lors de cette phase afin d évaluer la contribution corticale alors que la réponse posturale évolue. La troisième étude consiste principalement à appréhender la charge cognitive impliquée dans le contrôle sensori-moteur, en particulier lors d une chute, à l aide du paradigme de double-tâche. En conclusion, à travers une approche pluridisciplinaire, les résultats obtenus dans cette thèse permettent d émettre des recommandations intéressantes pour une prévention et une rééducation adaptée dans le but de contribuer à l amélioration de la qualité de vie des personnes âgées.A better understanding of what happens during an unintentional fall is relevant in preventing their occurrence. A fall is due to a failure of compensatory reactions to recover from postural perturbations during the descent phase which starts at the subject loss of balance point and lasts no more than 700-1000milliseconds [Hsiao, 1998]. The aim of the first study was to compare the biomechanical and muscular behavior during the pre-impact phase during non-recoverable falls and successful recovery trials. The experimental study aimed to evaluate the subject s ability to distinguish in the first 500 milliseconds following the onset of perturbation a low-threatening perturbation from a high challenging one and can then predict the scenario that will more likely lead to a fall using specific motor strategies. In such a challenging task, we hypothesized that the constraints imposed by the biomechanical properties ultimately determine the ability to trigger efficient muscle activities. Full body 3D kinematics and associated muscle activities were collected in 30 young healthy subjects during fast and slow unpredictable multidirectional support-surface translations. 40 cm support-surface translations were used to evoke the balancing reactions (0,35 vs 0,9 m/s during resp. 1000 vs 500 millisecond The perturbation velocities were selected so that successful recovery should occur in milder trials whereas fast trials were sufficiently challenging to trigger non-recoverable falls. Analyses focused on the spatial and temporal characteristics of the Centre of Mass, angle variations, recovery step characteristics, and EMG activities (onset latencies and amplitudes) across each trial and muscle. Moreover, a 17-segment numerical and personalized model was created, based on stereoradiographic head to feet X-ray images followed by 3D-reconstruction methods to assess subject-specific geometry and inertial parameters. The outputs resulting from simulated falls allowed us to discard the contributions of the passive (inertia-induced) versus the active mechanisms (feedback-controlled and time-delayed neuromuscular components) of the response. The first outcome of that study was that the fall could be divided in distinct phases. For about 200 milliseconds following the onset of platform translation, the head remained stable in space. Similarly, the comparison with the simulated data supported that the CoM displacement matched the subject-dependant mechanical model. During a second phase of the fall, despite the fact that automated muscle postural synergies started at 80 milliseconds after perturbation onset, the trajectory of the body appeared to be exclusively dictated by its biomechanical properties. Later, muscle activities influenced the body trajectories, which consequently differed on a trial-to-trial basis. The simulation was in good agreement with the experimental results. The specificity of the postural response resulting in a strategy chosen to avoid a fall thus appeared in a late-phase, which can be explained because during a fall, the subjects had to prepare to the impact on the basis of sensory information that were not redundant but available in a sequential order: proprioceptive information appearing first while vestibular and visual information continued to signal a stabilized head in space. The sole proprioceptive information would be insufficient to trigger rapid and appropriate postural response. Moreover, in accordance with our results suggesting the importance of the late-phase and on-line controlled responses, a long inertial passive phase in the fast trials does not allow a large spatiotemporal window for compensatory reactions to occur. These could not only depend on the previously described automated postural synergies because the time constraints imposed by biomechanics permit in principle volitional motricity to play an important role very early in the fall. (...)PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Inconsistent anticipatory postural adjustments (APAs) in rugby players : a source of injuries ?

Background: We are developing since 2010 with Thales and the Fédération Française de Rugby (FFR) M-Rex, a new kind of rugby scrum simulator. The study questioned whether it could improve safety and protect players from injury by using it as a tool for training/coaching the packs. Aim: To explore the anticipatory postural adjustments (APAs) during the engagement of the ruck, because these predictive neck and back muscles contractions protect the spinal cord at the time of impacts, which is crucial to prevent injuries. Methods: We quantified the kinematics and the EMG activities in high-level front row players during their initial engagement, when scrummaging with M-Rex. All studies were performed with one player interacting with the robot, at first, and then with the three players acting together. Results: For most of the tested high-level players, the APA latencies were highly variable from trial to trial even though the engagement resulted in similar impacts. At time, the onset of the electromyography activity in the neck and back muscles showed latencies inferior to 50 ms or even close to zero prior to the impact, which rendered muscle contractions inefficient as APAs. We were also unable to identify clear muscular synergies underlying the APAs because of their great variability on a trial-to-trial basis. Finally, the APAs were not related to the amplitude of the ensuing impact and were asymmetric in most trials. All these characteristics held true, whether the player was playing alone or with two other frontline players. Conclusion: Our result suggest that APAs should be systematically tested in high-level rugby players as well as in any high-level sport men at risk of neck and back injuries. Because APAs can be efficiently trained, our study paves the way to design individual position-specific injury prevention programme.This study was funded by Fédération Française de Rugb

Collaborative sensorimotor intelligence: the scrum as a model

AimUsing M-Rex, a rugby scrum simulator, we developed tools to describe scrummaging forces and to prevent accident.MethodsWe tested three groups of frontliners at national level. The simulator was passive or responded to the player(s) to simulate the reaction of opposite players. Sensors in the beam measured the force exerted by each of the players. Their movements were recorded with a Codamotion system.ResultsThe force signals exhibited two phases: a transient phase, similar to a damped sinusoid with a dominant frequency around 5 Hz when the players scrummaged alone and with a wider range when playing together; then, a sustained phase could be decomposed in two components: a DC component remained stable whether frontliners played alone or together. In contrast, its variability decreased when the frontliners played together compared with when they played alone. As for the oscillations, the frontliners exhibited a large variability in their ability to synchronise their efforts during the sustained phase. The synchronisation between the hooker and the props was quite efficient, while it was always missing between two props. Finally, we were able to study postural readjustments and their synchronisation among players during the sustained phase.ConclusionThis study shows that by using adequate methods, it is possible to assess the frontline collective intelligence. These findings may pave the way for innovative methods of training to improve players’ collective behaviour

Long-Lasting Visuo-Vestibular Mismatch in Freely-Behaving Mice Reduces the Vestibulo-Ocular Reflex and Leads to Neural Changes in the Direct Vestibular Pathway

International audienceCalibration of the vestibulo-ocular reflex (VOR) depends on the presence of visual feedback. However, the cellular mechanisms associated with VOR modifications at the level of the brainstem remain largely unknown. A new protocol was designed to expose freely behaving mice to a visuo-vestibular mismatch during a 2-week period. This protocol induced a 50% reduction of the VOR. In vivo pharmacological experiments demonstrated that the VOR reduction depends on changes located outside the flocculus/paraflocculus complex. The cellular mechanisms associated with the VOR reduction were then studied in vitro on brainstem slices through a combination of vestibular afferent stimulation and patch-clamp recordings of central vestibular neurons. The evoked synaptic activity demonstrated that the efficacy of the synapses between vestibular afferents and central vestibular neurons was decreased. In addition, a long-term depression protocol failed to further decrease the synapse efficacy, suggesting that the VOR reduction might have occurred through depression-like mechanisms. Analysis of the intrinsic membrane properties of central vestibular neurons revealed that the synaptic changes were supplemented by a decrease in the spontaneous discharge and excitability of a subpopulation of neurons. Our results provide evidence that a long-lasting visuo-vestibular mismatch leads to changes in synaptic transmission and intrinsic properties of central vestibular neurons in the direct VOR pathway. Overall, these results open new avenues for future studies on visual and vestibular interactions conducted in vivo and in vitro