Magnitude Of Anticipatory Postural Adjustments Research Articles

Can People with Parkinson's Disease Self-Trigger Gait Initiation? A Comparison of Cueing Strategies.

An external cue can markedly improve gait initiation in people with Parkinson's disease (PD) and is often used to overcome freezing of gait (FOG). It is unknown if the effects of external cueing are comparable if the imperative stimulus is triggered by the person receiving the cue (self-triggered) or an external source. Two experiments were conducted to compare the effects of self- versus externally triggered cueing on anticipatory postural adjustments (APAs) during gait initiation in people with PD. In experiment 1, 10 individuals with PD and FOG initiated gait without a cue or in response to a stimulus triggered by the experimenter or by the participant. Experiment 2 compared self- versus externally triggered cueing across three groups: healthy young adults (n = 16), healthy older adults (n = 11), and a group with PD (n = 10). Experiment 1: Externally triggered cues significantly increased APA magnitudes compared to uncued stepping, but not when the same cue was self-triggered. Experiment 2: APAs were not significantly improved with a self-triggered cue compared to un-cued stepping in both the PD and healthy older adult groups, but the young adults showed a significant facilitation of APA magnitude. The effectiveness of an external cue on gait initiation in people with PD and older adults is critically dependent upon whether the source of the trigger is endogenous (self-produced) or exogenous (externally-generated). These results may explain why cueing interventions that rely upon self-triggering of the stimulus are often ineffective in people with PD.

Age-Related Changes of the Anticipatory Postural Adjustments During Gait Initiation Preceded by Vibration of Lower Leg Muscles.

Gait initiation (GI) challenges the balance control system, especially in the elderly. To date, however, there is no consensus about the age effect on the anticipatory postural adjustments (APAs). There is also a lack of research on APAs in older adults after proprioceptive perturbation in the sagittal plane. This study aimed to compare the ability of young and older participants to generate APAs in response to the vibratory-induced perturbation delivered immediately before GI. Twenty-two young and 22 older adults performed a series of GI trials: (1) without previous vibration; (2) preceded by the vibration of triceps surae muscles; and (3) preceded by the vibration of tibialis anterior muscles. The APAs magnitude, velocity, time-to-peak, and duration were extracted from the center of pressure displacement in the sagittal plane. Young participants significantly modified their APAs during GI, whereas older adults did not markedly change their APAs when the body vertical was shifted neither backward nor forward. Significant age-related declines in APAs were observed also regardless of the altered proprioception.The results show that young adults actively responded to the altered proprioception from lower leg muscles and sensitively scaled APAs according to the actual position of the body verticality. Contrary, older adults were unable to adjust their postural responses indicating that the challenging transition from standing to walking probably requires higher reliance on the visual input. The understanding of age-related differences in APAs may help to design training programs for the elderly specifically targeted to improve balance control in different sensory conditions, particularly during gait initiation.

An external focus of attention compared to an internal focus of attention improves anticipatory postural adjustments among people post-stroke

BackgroundPeople after stroke often have postural impairments that can increase their risk of falling. Anticipatory postural adjustments (APAs) are changes in the activity of postural muscles prior to a voluntary movement in order to maintain vertical equilibrium. Previous research suggests that improving APAs leads to better postural control and reduces the risk of falls. Despite the importance of APAs and their impairment among people post-stroke, studies that aim to investigate methods for improving APAs are limited. Consistent evidence supports that an external focus of attention compared to an internal focus of attention, yields superior performance of motor skills that include postural control. Research questionWhat are the effects of adopting different foci of attention on measures of APAs and movement parameters when performing a lower extremity Fitts’ task among people post-stroke? MethodsTwelve individuals post-stroke performed a lower extremity stepping movement (Fitts’ task) while adopting an external focus or an internal focus of attention in a within-subject design. A motion capture system was used to record participants’ movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at endpoint (SDT). Electromyography was used to measure muscle activity and determine APAs onset and magnitude. For all dependent variables separate repeated measures ANOVAs were conducted to compare performance between foci of attention. ResultsThe results showed that an external focus of attention yielded significantly better performance on all outcome measures. The improvement in performance was seen in shorter MT, higher PV, shorter ttPV, smaller SDT, earlier APAs onset and more efficient APAs magnitude. SignificanceThe changes in outcome measures suggest that adopting an external focus of attention during postural tasks could be an effective strategy for improving balance control among people post-stroke.

Anticipatory postural adjustments during a Fitts’ task: Comparing young versus older adults and the effects of different foci of attention

Anticipatory postural adjustments (APAs) are an integral part of standing balance. Previous research with balance control has shown that adopting an external focus of attention, compared to an internal focus of attention, yields better performance during motor skills. Despite the importance of APAs, especially among older adults, and the potential benefits of adopting an external focus of attention, studies investigating methods for improving APAs are limited. The aim of this study was to compare behavioral, kinematic and APAs measures while adopting different foci of attention among young and older adults when performing a lower extremity Fitts’ task. Ten young adults (mean age 24 years ± 4.37) and ten older adults (mean age 75 years ± 5.85) performed a lower-extremity reaching task (Fitts’ task) while adopting an external focus (focus on target) and an internal focus (focus on limb) in a within-subject design. A motion capture system was used to record participants’ movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at target (SDT). Electromyography (EMG) was used to determine APAs onset and magnitude. The findings showed that an external focus of attention led to significantly shorter MT, higher PV, shorter ttPV and more accuracy when reaching the target (SDT) for both age groups. Also, EMG results showed that, with an external focus, APAs onset occurred earlier and APAs magnitude was more efficient. As predicted by Fitts’ Law, participants spent more time executing movements to targets with higher indices of difficulty. Older adults compared to young adults were more adversely affected by the increase of difficulty of the Fitts’ task, specifically, on measures of APAs. In conclusion, adopting an external focus of attention led to better overall movement performance when performing a lower extremity Fitts’ task. The task used in the present study can distinguish between APAs for older and young adults. We recommend that future studies expand on our findings in order to establish a performance-based objective measure of APAs to assess clinical interventions for postural control impairment.

Asymmetrical stabilization and mobilization exploited during static single leg stance and goal directed kicking

The motor control properties of the right and left legs are dependent on the stabilization and mobilization features of the motor tasks. The current investigation examined the right and left leg control differences – interlateral asymmetries – during static single leg stance and dynamic goal directed kicking with an emphasis of the asymmetrical stabilization and mobilization components of movements. Ten young, healthy, right-leg preferred individuals with minimal kicking experience completed both tests on each limb. During static single leg stance, participants were requested to stand as still as possible with one leg in contact with a force platform. Interlateral asymmetries of the standing leg were quantified using postural variability measures of the center of pressure (COP) standard deviation in the anterior-posterior (SD-COPAP) and medial-lateral (SD-COPML) directions, resultant COP length and velocity, and 95% COP elliptical area. During dynamic goal directed kicking, participants stood on two adjacent force platforms in a side-by-side foot position and kicked a soccer ball toward three different directions as soon as they received an auditory cue of kicking. Three targets were located −30°, 0° or 30° in front and 3.05 m away from the participants’ midline. Participants kicked the ball toward the targets with each of their feet. The vertical ground reaction force (vGRF) of the kicking leg was used to define the preparation (from above two standard deviations of vGRF baseline to toe-off) and swing (from toe-off to toe-return) phases of dynamic kicking. To determine the presence of interlateral asymmetries during dynamic kicking, the magnitude and timing of the anticipatory postural adjustments (APA) during the preparation phase of kicking were quantified using the lateral net COP (COPnet-ML) time series derived from both force platforms. Postural variability measures of the support leg and the kinematic joint range of motion (JROM) trajectories of the kicking leg were also used to examined interlateral asymmetries. During static stance, no between-leg significance was identified for all dependent measures of COP variability suggesting symmetrical stabilization. During the preparation phase of kicking, both right and left leg kicking exhibited a similar level of APA magnitude, although the left leg kicking was shown to reach its maximum APA magnitude earlier than the right leg. In the support leg role, the right leg showed greater COP variability in the ML direction as compared to the left support leg and greater COP variability was observed when kicking in the ipsilateral direction compared to the center and contralateral directions. For mobilization control, the left kicking leg showed greater JROM displacements at the distal (knee and ankle) joints and reduced JROM primarily with hip frontal plane movements compared to the right kicking leg. The reported interlateral asymmetries during kicking may reflect a behavioral adaptation that results in differential stabilization between the right and left legs. Overall, the findings suggest that novel tasks, such as dynamic goal directed kicking, appear to be more sensitive than static balance in identifying interlateral asymmetries.

Impaired motor preparation and execution during standing reach in people with chronic stroke

Movement preparation of both anticipatory postural adjustments (APAs) and goal directed movement during a standing reaching task in adults with chronic hemiparesis and healthy controls was investigated. Using a simple reaction time paradigm, while standing on two separate force platforms, subjects received a warning light cue to “get ready to reach” followed 2.5s later by an imperative light cue to “reach as quickly as possible” with the paretic arm (matched arm for controls) to touch a target in front of them for a total of 90 trials. In 30 of the reaching trials a loud acoustic stimulus (LAS) of 123 dB was randomly − −200, or 0ms relative to the “go” cue. APA (postural) responses were characterized by the onset and maximal posterior displacement of center of pressure (CoP) and onset/offset of electromyography (EMG) from tibialis anterior (TA), soleus (SOL), while reach was characterized by onset and maximal forward displacement of the reach hand and onset of the anterior (AD), biceps brachii (BB) and middle deltoid (MD). Subjects with stroke, demonstrated a marked reduction in the occurrence of the StartReact responses for both APA and forward reach at all LAS time points indicating movement preparation dysfunction. Movement execution during a cued reach showed significant delays in APA and reach onsets, significant reduction in the magnitude of APA (posterior CoP displacement) and reach excursion, and an increased latency between the APA and reach compared to controls. EMG activation patterns for the TA and SOL demonstrated co contraction compared to the temporally sequenced pattern of control subjects. When LAS was provided at the “go” there were earlier but not significant differences in APA onset latency compared to reaching without LAS and significant delays in reach onset latency when compared to control subjects with or without LAS. An early burst of EMG in biceps brachii muscles with a further delay of the reach onset compared to reaching without LAS may be indicative of interference of a classical startle reflex activating elbow flexors. Results indicated impairments in movement preparation of both APA’s and goal directed UE movement in individuals with stroke which impact the functional performance of reaching in the standing position.

The effect of load uncertainty on anticipatory muscle activity in catching

To investigate how the CNS copes with load uncertainty in catching, anticipatory postural adjustments (APAs) in one-handed catching of balls of known and unknown weights were compared. Twenty-nine (n=29) men (mean age=21.1years) participated, all of whom had engaged in a sport activity requiring hand-eye coordination. Participants' muscle activity in the biceps brachii, triceps brachii, wrist flexor group, and bilateral erector spinae at L4-5 was recorded using electromyography (EMG) while they caught visually identical balls of four different weights (0.5, 1.33, 2.17, and 3.0kg). EMG integrals were computed for the 1s prior to ball drop (pre-drop period), and the interval between ball drop and catch (drop period). Uncertainty about ball weight had no effect on APA activity during the pre-drop period. During the drop period, however, load uncertainty did influence APA activity in the biceps brachii, triceps brachii, and the wrist flexor muscles (i.e., the effect of ball weight on APA magnitude depended on the presence or absence of load knowledge). In the known ball weight condition, participants exhibit greater APA magnitude with increases in ball weight. In contrast, under the unknown ball weight condition, APA magnitude was relatively consistent across ball weights and at a level similar to the APA magnitude for an intermediate weight (i.e., the second heaviest ball of four) in the known weight condition. In catching balls of unknown weights, the CNS appears to scale APA magnitude to afford the greatest chance of catching the ball, regardless of the weight.

Feedforward postural control in individuals with multiple sclerosis during load release

The aim of the present study was to investigate the organization of anticipatory postural adjustments (APAs) in individuals with multiple sclerosis (MS) during self-initiated perturbation in the sagittal plane. Eleven individuals with MS and eleven age-and-gender matched healthy controls were asked to hold a 2.27kg load in the extended arms and release it using fast arm abduction movements. Electrical activity of six leg and trunk muscles as well as displacements of the center of pressure (COP) were recorded. The results indicate that individuals with MS (1) demonstrate a reduced magnitude of APAs, (2) delayed latency of APAs and (3) smaller anticipatory COP displacement as compared to healthy control subjects. Moreover, in spite of individuals with MS being mildly affected, their balance capacity was significantly diminished. Thus, the outcome of this study demonstrates the underlying impairment in anticipatory postural control of individuals with MS and provides a background for development of rehabilitation strategies focused on balance restoration in this population.

Stability limits modulate whole-body motor learning

Our daily movements exert forces upon the environment and also upon our own bodies. To control for these forces, movements performed while standing are usually preceded by anticipatory postural adjustments (APAs). This strategy is effective at compensating for an expected perturbation, as it reduces the need to compensate for the perturbation in a reactive manner. However, it can also be risky if one anticipates the incorrect perturbation, which could result in movements outside stability limits and a loss of balance. Here, we examine whether the margin for error defined by these stability limits affects the amount of anticipation. Specifically, will one rely more on anticipation when the margin for error is lower? Will the degree of anticipation scale with the margin for error? We took advantage of the asymmetric stability limits (and margins for error) present in the sagittal plane during upright stance and investigated the effect of perturbation direction on the magnitude of APAs. We also compared anticipatory postural control with the anticipatory control observed at the arm. Standing subjects made reaching movements to multiple targets while grasping the handle of a robot arm. They experienced forward or backward perturbing forces depending on the target direction. Subjects learned to anticipate the forces and generated APAs. Although subjects had the biomechanical capacity to adapt similarly in the forward and backward directions, APAs were reduced significantly in the backward direction, which had smaller stability limits and a smaller margin for error. Interestingly, anticipatory control produced at the arm, where stability limits are not as relevant, was not affected by perturbation direction. These results suggest that stability limits modulate anticipatory control, and reduced stability limits lead to a reduction in anticipatory postural control.

Anticipatory postural adjustments in reach-to-grasp: Effect of object mass predictability

Anticipatory postural adjustments (APAs) are thought to compensate for upcoming and predictable perturbations before they occur, e.g., a backward shift of the body center of pressure (COP) before raising the arm. When the goal of arm movements is to reach, grasp, and manipulate an object, predicting the effect of raising the arm on body COP before reach onset could incorporate the properties of the object to be lifted, as both will affect postural control during reaching and object manipulation. Alternatively, the central nervous system (CNS) might use separate APAs to compensate for the effect of arm raising from raising the arm and object. To distinguish between these two scenarios, we asked subjects to reach, grasp, and lift an object whose mass (100g, 750g, or 1400g) was either constant across trials or variable from trial to trial (‘predictable’ and ‘unpredictable’ condition, respectively). We hypothesized that object mass would affect the magnitude of APAs in the predictable condition before the onset of object lift but not before the initial arm onset. We also expected COP variability following object lift to be reduced as a result of APAs. For the unpredictable condition, we expected ‘default’ APAs that would minimize postural perturbation following object lift. We found that both magnitude and timing of APAs were modulated as a function of predictable object mass prior to contact, rather than at the onset of the reaching movement. Specifically, COP position moved forward with increasing object load (p<0.05) and peak COP velocity related to object contact occurred significantly early for heavier loads (p<0.05). For the random condition, the COP position and timing at all loads resembled that associated with larger predictable loads. These findings suggest that modulating COP to a future event might be more accurate when timed to temporally close events, thus potentially reducing the computational load as well as risks of prediction errors. Additionally, our results might suggest limitations in the predictive capability of the CNS in relation to ‘how far in the future’ it can go when predicting the consequences of planned actions.

Does movement planning follow Fitts' law? Scaling anticipatory postural adjustments with movement speed and accuracy

We wanted to determine whether movement planning followed Fitts' law by investigating the relationship between movement planning and movement performance in experienced dancers executing a typical classical ballet step in which the big toe was pointed to targets at different distances and of different widths so as to obtain several indices of difficulty (ID). Movement time, velocity and variability at the target were the variables of movement performance kinematics; movement planning was evaluated by analysis of anticipatory postural adjustments (APAs) to assess their modulation at different IDs. Movement time and peak of velocity were found to scale with the ID only when individual movement distance across target widths was entered into the analysis. APA magnitude and duration both scaled according to movement parameters but not in the same way. APA magnitude scaled with movement velocity, while APA duration was sensitive to the amplitude-to-accuracy ratio following the ID for movements performed in the shortest time interval when on-line feedback control is probably not available. Here we show that timing of muscle activation acts as an independent central command that triggers fine-tuning for speed-accuracy trade-off.

Anticipatory postural adjustments prior to step initiation are hypometric in untreated Parkinson’s disease: an accelerometer‐based approach

Anticipatory postural adjustments (APAs), prior to step initiation, are bradykinetic in advanced Parkinson's disease (PD) and may be one of the factors associated with 'start hesitation'. However, little is known about APAs in the early stage of PD. In this study, we determined whether body-worn accelerometers could be used to characterize step initiation deficits in subjects with early-to-moderate, untreated PD. Eleven PD and 12 healthy control subjects were asked to take two steps. Postural adjustments were compared from center of pressure (COP) and from acceleration of the trunk at the center of mass level (L5). Our findings show that APAs measured from the peak COP displacement toward the swing leg and the peak trunk acceleration toward the stance leg were smaller in untreated PD compared with control subjects. The magnitude of APAs measured from peak COP displacements and accelerations were correlated. These results suggest that quantitative analysis of step initiation from one accelerometer on the trunk could provide useful information for the characterization of patients in early stages of PD, when clinical evidence of start hesitation may not be detectable. Ambulatory monitoring of step initiation is also promising for monitoring patient progression in the home environment, and eventually providing feedback for preventing freezing of gait episodes.

Anticipatory postural adjustments associated with arm movement in Parkinson’s disease: a biomechanical analysis

Objective: To study anticipatory postural adjustments (APAs) in Parkinson’s disease (PD) via a biomechanical analysis, including vertical torque (Tz). Methods: Ten patients with PD (in the “off-drug” condition) and 10...

Step initiation in Parkinson's disease: Influence of initial stance conditions

In this study, we investigated how the size of preparatory postural adjustments prior to step initiation, and step length and velocity depend on initial stance width in patients with Parkinson's disease (PD) both in the ON and OFF levodopa states and in healthy elderly subjects. Twenty-one subjects with idiopathic PD and 24 age-matched healthy control subjects took two steps starting with feet on a two-plate force-platform, from either narrow or wide stance width. We measured how the magnitude of anticipatory postural adjustments (APA) and step characteristics scaled with stance width. Results showed that preparation for step initiation from wide stance was associated with a larger lateral and backward center of pressure (CoP) displacement than from narrow stance. Velocity and length of the first step were also sensitive to initial stance conditions, probably in relation with the differences in the corresponding APA. On the contrary, the duration of APA was not significantly affected by initial stance width, but it was longer in PD compared to healthy subjects, and speeded up by levodopa. Although subjects with PD did scale up the size of their APA with stance width, they had much more difficulty initiating a step from a wide stance than from a narrow stance, as shown by the greater differences from control subjects in the magnitude of the APA. Our results support the hypothesis that PD subjects maintain a narrow stance as a compensation for their inability to sufficiently increase the size of their lateral APA to allow fast step initiation in wide stance.

The effects of muscle vibration on anticipatory postural adjustments

The current study investigated the influence of changes in sensory information related to postural stability on anticipatory postural adjustments (APAs) in standing subjects. Subjects performed fast arm movements and a load release task while standing on a stable force platform or on an unstable board. We manipulated sensory information through vibration of the Achilles tendons and additional finger touch (contact forces under 1 N). Changes in the background activity of leg, trunk, and arm muscles and displacements of the center of pressure (COP) were quantified within time intervals typical for APAs. In the arm movement task, leg and trunk muscles showed a significant drop in the APAs with finger touch, while the vibration and standing on the unstable board each led to an increase in the APA magnitude. In the load release task, ventral muscles decreased their APA activity with touch, while dorsal muscles showed increased inhibition during APAs. During vibration, dorsal and ventral muscles showed increased excitation and inhibition during APAs, respectively. An additional analysis of APAs at a joint level, has shown that in both tasks, an index related to the co-activation of agonist–antagonist muscle pairs (C-index) was modulated with touch, vibration, and stability particularly in leg muscles. Small changes in the other index related to reciprocal activation (R-index) were found only in trunk muscles. Light touch and vibration induced opposing changes in the C-index, suggesting their opposite effects on the stabilization of a reference point or vertical. We conclude that the central nervous system deploys patterns of adjustments in which increased co-contraction of distal muscles and reciprocal adjustments in trunk muscles are modified to ensure equilibrium under postural instability.

Anticipatory postural adjustments during load catching by standing subjects

Objectives: (1) To study differences in the generation of anticipatory postural adjustments (APAs) in arm and trunk/leg muscles prior to catching a load released either by the subject him-/herself or by the experimenter. (2) To study the importance of different mechanical characteristics of the load at impact for the generation of APAs prior to load catching.Methods: Standing subjects were asked to catch loads dropped onto the left hand from different heights either by the experimenter or by the subject's right hand. The load mass and release height were manipulated to keep either the mass or the momentum of the load at impact constant. APAs were quantified with integral electromyographic indices.Results: APAs were observed in leg, trunk and arm muscles prior to load impact for both self- and experimenter-release trials. Kinetic energy showed higher correlations with the magnitude of APA than momentum, but only in experimenter-release trials.Conclusions: Subjects can generate APAs in both arm and trunk/leg muscles in the absence of an explicit voluntary action. The relative importance of kinetic energy and momentum for defining the magnitude of APAs can reflect the difference in the sources of information used to prepare for the forthcoming perturbation during self- and experimenter-released load catch.

The roles of proximal and distal muscles in anticipatory postural adjustments under asymmetrical perturbations and during standing on rollerskates

Objectives: The study addresses two controversial issues surrounding the nature of anticipatory postural adjustments (APAs). The first deals with the reproducible APA patterns in proximal postural muscles and variable APA patterns reported for the muscles controlling the ankle joint (TA-SOL). We hypothesized that the TA-SOL muscles participate mainly in the compensation of lateral and rotational perturbations, in particular those associated with asymmetrical movements. The second issue deals with decreased APAs reported during both very stable and unstable standing. We hypothesized that APA changes during unstable standing might depend on the actual mechanical nature of instability. Methods: Eight healthy subjects were recruited who had had no prior experience with rollerskates. They performed series of bilateral and unilateral, flexion and extension movements during regular standing and bilateral movements during standing on rollerskates. EMG changes and shifts of the center of pressure were analyzed within a time window typical of APAs. Results: We found that APAs in proximal muscles were decreased during unilateral shoulder movements as compared to APAs during bilateral movements but did not show right–left differences. In contrast, the distal muscles (TA-SOL) showed little involvement during bilateral movements, while a clear right–left asymmetry was seen during unilateral movements. Bilateral movements performed while standing on rollerskates were accompanied by unchanged APAs in the proximal muscle pairs and increased APAs in the TA-SOL pair. Conclusions: We conclude that the proximal muscles provide a general pattern counteracting expected perturbations in the anterior-posterior direction while the distal muscles deal with asymmetrical perturbations and the modulation of APAs in unusual conditions such as standing on rollerskates. There seems to be no unambiguous relation between the magnitude of APAs and the stability of standing: Depending on the exact mechanical nature of postural instability, it could be associated with qualitatively different changes in the APAs.

The role of motor action in anticipatory postural adjustments studied with self-induced and externally triggered perturbations.

This study investigated the relation between the magnitude of a motor action triggering a postural perturbation and the magnitude of anticipatory postural adjustments. Subjects stood on a force platform and held, in extended arms, a balloon with a 2.2-kg load suspended on a rigid cord. In different series, unloadings were induced by fast bilateral shoulder abduction movements, by popping the balloon with a tack taped to the subject's right middle finger, or by the experimenter popping the balloon. Anticipatory postural adjustments were seen during all self-initiated unloadings as changes in the level of activation of postural muscles and in displacements of the center of pressure. However, absolute values of these changes were significantly smaller in the series with balloon popping as compared to the series with shoulder abductions. Such reactions were absent when the unloading was triggered by the experimenter. We conclude that a self-triggered perturbation is always associated with anticipatory postural adjustments, while the magnitude of the adjustments may be scaled with respect to the magnitude of a motor action used to induce the perturbation.