The effect of age-related declines in proprioception and total knee replacement on postural control.

BACKGROUND: An experiment was designed to examine the effects of a decrease in threshold joint position sense (TJPS) at the knee and ankle and of total knee replacement (TKR) on postural control in older adults. It was hypothesized that older adults with a decrease in TJPS and those who had undergone TKR would display increased center of pressure (COP) variance during quiet stance and late onsets for muscle responses to balance threats. METHODS: Older adult subjects (> or = 70 years) were evaluated and grouped according to the status of their ankle and knee threshold joint position sensation as well as their surgical history. COP data were collected while subjects stood on a force plate with feet together under eyes-open and -closed conditions. Threats to balance were given using a platform that moved forward and backward. RESULTS: Older subjects with poor knee extension TJPS had significantly increased COP variance, although those with very poor knee flexion and extension TJPS demonstrated even greater increases. Similarly, subjects with decreased ankle TJPS demonstrated increased COP variance. However, reduced TJPS did not affect the ability of subjects to respond to threats to balance. Post-TKR subjects showed no reductions in any aspect of postural control. CONCLUSIONS: This study showed that the task of standing quietly has a direct relationship to threshold JPS, although the task of recovering from an abrupt perturbation does not. Older adult TKR results suggest that there is no negative effect on balance from elective joint replacement.

Influence of auditory precuing on automatic postural responses.

An experiment was conducted to determine the influence of auditory precuing on posture control. Specifically, the influence of a warning signal on the onset latencies of the gastrocnemius (G) and tibialis anterior (TA) muscles was determined. An audible 50-ms tone was presented to subjects standing on a moveable platform and preceded a perturbation to standing balance by 500 ms. The perturbations were produced by an anterior or posterior translation (3 cm at 30 cm/s) of the support surface. Unilateral electromyographic activity was recorded from G and TA muscles. In the first series of trials (series A), the muscle onset latencies following perturbations with a nondirectionally specific precue, an invalid precue, and no precue were compared. In the second series of trials (series B), muscle onset latencies following perturbations with a directionally specific precue, invalid precue, and no precue perturbations were compared. In series A, mean muscle onset latencies decreased following nondirectionally specific precues during forward and backward platform perturbations; respectively, TA 6% (91 +/- 9 ms to 86 +/- 9 ms) and G 7% (93 +/- 6 ms to 87 +/- 5 ms). During series B, the TA and G muscle onset latencies decreased following directionally specific precues by 10.4% (92 +/- 12 ms to 82 +/- 6 ms) and 9.8% (92 +/- 9 ms to 83 +/- 6 ms), respectively. There were no significant differences between the types of precues. Thus, prior knowledge of a forthcoming balance perturbation reduces postural muscle onset latency times. In addition, specific prior knowledge reduces muscle onset latency time in the same manner as does nonspecific prior knowledge.