Interference between postural control and spatial vs. non-spatial auditory reaction time tasks in older adults.

This study investigated whether spatial aspects of an information processing task influence dual-task interference. Two groups (Older/Young) of healthy adults participated in dual-task experiments. Two auditory information processing tasks included a frequency discrimination choice reaction time task (non-spatial task) and a lateralization choice reaction time task (spatial task). Postural tasks included combinations of standing with eyes open or eyes closed on either a fixed floor or a sway-referenced floor. Reaction times and postural sway via center of pressure were recorded. Baseline measures of reaction time and sway were subtracted from the corresponding dual-task results to calculate reaction time task costs and postural task costs. Reaction time task cost increased with eye closure (p = 0.01), sway-referenced flooring (p < 0.0001), and the spatial task (p = 0.04). Additionally, a significant (p = 0.05) task x vision x age interaction indicated that older subjects had a significant vision X task interaction whereas young subjects did not. However, when analyzed by age group, the young group showed minimal differences in interference for the spatial and non-spatial tasks with eyes open, but showed increased interference on the spatial relative to non-spatial task with eyes closed. On the contrary, older subjects demonstrated increased interference on the spatial relative to the non-spatial task with eyes open, but not with eyes closed. These findings suggest that visual-spatial interference may occur in older subjects when vision is used to maintain posture.

Postural adjustment errors during lateral step initiation in older and younger adults.

The purpose was to examine age differences and varying levels of step response inhibition on the performance of a voluntary lateral step initiation task. Seventy older adults (70-94 years) and twenty younger adults (21-58 years) performed visually cued step initiation conditions based on direction and spatial location of arrows, ranging from a simple choice reaction time task to a perceptual inhibition task that included incongruous cues about which direction to step (e.g., a left pointing arrow appearing on the right side of a monitor). Evidence of postural adjustment errors and step latencies were recorded from vertical ground reaction forces exerted by the stepping leg. Compared with younger adults, older adults demonstrated greater variability in step behavior, generated more postural adjustment errors during conditions requiring inhibition, and had greater step initiation latencies that increased more than younger adults as the inhibition requirements of the condition became greater. Step task performance was related to clinical balance test performance more than executive function task performance.

Functional brain imaging of multi-sensory vestibular processing during computerized dynamic posturography using near-infrared spectroscopy.

Functional near-infrared spectroscopy (fNIRS) is a non-invasive brain imaging method that uses light to record regional changes in cerebral blood flow in the cortex during activation. fNIRS uses portable wearable sensors to allow measurements of brain activation during tasking. In this study, fNIRS was used to investigate how the brain processes information from multiple sensory modalities during dynamic posturography. Fifteen healthy volunteers (9M/6F; ages 28+/-9 yrs) participated in the posturography study while undergoing fNIRS brain imaging. Four standard conditions from the sensory organization test (SOT) were performed and a bilateral fNIRS probe was used to examine the cortical brain responses from the frontal, temporal, and parietal brain regions. We found that there was bilateral activation in the temporal-parietal areas (superior temporal gyrus, STG, and supramarginal gyrus, SMG) when both vision and proprioceptive information were degraded; forcing reliance on primarily vestibular information in the control of balance. This is consistent with previous reports of the role of these regions in vestibular control and demonstrates the potential utility of fNIRS in the study of cortical control of vestibular function during standing balance tasks.

Postural adjustment errors reveal deficits in inhibition during lateral step initiation in older adults.

Postural dual-task studies have demonstrated effects of various executive function components on gait and postural control in older adults. The purpose of the study was to explore the role of inhibition during lateral step initiation. Forty older adults participated (range 70-94 yr). Subjects stepped to the left or right in response to congruous and incongruous visual cues that consisted of left and right arrows appearing on left or right sides of a monitor. The timing of postural adjustments was identified by inflection points in the vertical ground reaction forces (VGRF) measured separately under each foot. Step responses could be classified into preferred and nonpreferred step behavior based on the number of postural adjustments that were made. Delays in onset of the first postural adjustment (PA1) and liftoff (LO) of the step leg during preferred steps progressively increased among the simple, choice, congruous, and incongruous tasks, indicating interference in processing the relevant visuospatial cue. Incongruous cues induced subjects to make more postural adjustments than they typically would (i.e., nonpreferred steps), representing errors in selection of the appropriate motor program. During these nonpreferred steps, the onset of the PA1 was earlier than during the preferred steps, indicating a failure to inhibit an inappropriate initial postural adjustment. The functional consequence of the additional postural adjustments was a delay in the LO compared with steps in which they did not make an error. These results suggest that deficits in inhibitory function may detrimentally affect step decision processing, by delaying voluntary step responses.

Visual-vestibular stimulation influences spatial and non-spatial cognitive processing.

This study investigated the impact of visual-vestibular stimulation on performance of an auditory information processing task in young and older adults. Performance on a spatial choice reaction time task was compared to performance on a non-spatial choice reaction time task. The tasks were performed during simultaneous rotational and moving visual stimulation. The non-spatial task was an auditory frequency discrimination task while the spatial task was a right-left lateralization task. Visual and vestibular conditions consisted of a non-movement baseline, sinusoidal earth-vertical axis rotation (EVAR) in darkness, off-vertical axis rotation (OVAR) in darkness at a constant velocity, OVAR in darkness with a sinusoidal profile, EVAR with a lighted visual surround, constant velocity optokinetic stimulation, and sinusoidal optokinetic stimulation. Baseline reaction times were subtracted from reaction times during each stimulus condition to yield "task cost", which was analyzed statistically. Subjects were healthy young (n=20; 24 ± 2.7 yrs; 10F) and older (n=29; 73 ± 6.0 yrs; 18F) adults. Results indicated that task cost was affected by the visual-vestibular condition and a task x condition interaction. There was no main effect of task or age group and no significant interaction with age. Otolithic stimulation and visual stimulation were associated with greater task cost compared to semicircular canal stimulation. Combining semicircular canal with otolithic or visual stimulation had no additional effect beyond otolithic or visual stimulation alone. This pattern of task cost being larger for otolith or visual vs. semicircular canal stimulation was found for both the spatial and non-spatial tasks. The significant interaction between condition and task type revealed that the task cost for the spatial task was larger than the task cost for the non-spatial task during visual conditions but not during non-visual conditions although the visual and non-visual conditions were not entirely comparable. This study suggests that interference of vestibular stimulation with cognitive processing is especially prominent for otolithic and visual stimulation although the strength of the various visual-vestibular stimuli may not have been uniform. Also, spatial tasks are more affected than non-spatial tasks during visual stimulation and interference between vestibular stimulation and cognitive processing is not age dependent for these relatively easy tasks.

Guidelines for the use of wheelchair postural support devices during travel in motor vehicles.

Questions are often raised about whether the use of postural support devices while seated in a wheelchair during travel in a motor vehicle can have potential benefits or result in harm. The benefits or harm are generally unknown as current crash-test dummies are not designed to evaluate postural supports, and there are little to no injury data for these devices in the motor-vehicle environment. Despite these limitations, guidelines and best practices can be developed for use of postural support devices during travel in a motor vehicle using basic principles of occupant protection and knowledge about injury biomechanics. This document presents guidelines and recommendations for postural support devices used on wheelchairs that also serve as seats in motor vehicles. It addresses the basic principles of safe transportation for wheelchair-seated occupants and provides guidelines and recommendations for use of specific devices during transportation.

Characterization of pediatric wheelchair kinematics and wheelchair tiedown and occupant restraint system loading during rear impact.

This study characterizes pediatric wheelchair kinematic responses and wheelchair tiedown and occupant restraint system (WTORS) loading during rear impact. It also examines the kinematic and loading effects of wheelchair headrest inclusion in rear impact. In two separate rear-impact test scenarios, identical WC19-compliant manual pediatric wheelchairs were tested using a seated Hybrid III 6-year-old anthropomorphic test device (ATD) to evaluate wheelchair kinematics and WTORS loading. Three wheelchairs included no headrests, and three were equipped with slightly modified wheelchair-mounted headrests. Surrogate WTORS properly secured the wheelchairs; three-point occupant restraints properly restrained the ATD. All tests used a 26km/h, 11g rear-impact test pulse. Headrest presence affected wheelchair kinematics and WTORS loading; headrest-equipped wheelchairs had greater mean seatback deflections, mean peak front and rear tiedown loads and decreased mean lap belt loads. Rear-impact tiedown loads differed from previously measured loads in frontal impact, with comparable tiedown load levels reversed in frontal and rear impacts. The front tiedowns in rear impact had the highest mean peak loads despite lower rear-impact severity. These outcomes have implications for wheelchair and tiedown design, highlighting the need for all four tiedowns to have an equally robust design, and have implications in the development of rear-impact wheelchair transportation safety standards.

Effect of wheelchair headrest use on pediatric head and neck injury risk outcomes during rear impact.

Comparative risks or benefits to wheelchair-seated pediatric occupants in motor vehicles associated with wheelchair headrest use during rear impact were evaluated using pediatric head and neck injury outcome measures. A Hybrid III 6-year-old anthropomorphic test device (ATD), seated in identical WC19-compliant pediatric manual wheelchairs, was used to measure head and neck response during a 25 km/h (16 mph), 11 g rear impact. ATD responses were evaluated across two test scenarios: three sled tests conducted without headrests, and three with slightly modified commercial headrests. Head and neck injury outcomes measures included: linear head acceleration, head injury criteria (HIC) values, neck injury criteria (N(ij)) values, and combined rotational head velocity and acceleration. Neck and head injury outcome measures improved by 34-70% in sled tests conducted with headrests compared to tests without headrests. Headrest use reduced N(ij) values and the likelihood of concussion from values above established injury thresholds to values below injury thresholds. Injury measure outcome reductions suggest lower head and neck injury risks for wheelchair-seated children using wheelchair-mounted headrests as compared to non-headrest users in rear impact. Use of relative comparisons across two test scenarios served to minimize effects of ATD biofidelity limitations.