Effect of Repetitive Sub-concussive Head Impacts on Ocular Near Point of Convergence.

This study intended to examine effects of repetitive sub-concussive head impacts on ocular near point of convergence (NPC). 20 healthy young adult soccer players were assigned to either a heading or control group. Heading subjects completed 10 headers of soccer balls projected at a speed of 11.2 m/s. Control subjects did not perform heading. Linear head acceleration was measured with a triaxial accelerometer. The NPC assessment was performed at pre-, 0 h post-, and 24 h post-heading. During the NPC assessment participants were seated and a visual target was moved towards the eyes at 1cm/sec. The participant signaled when he/she experienced diplopia or deviation of the eye was observed, and the distance was recorded. The assessment was repeated twice and average NPC scores were used for further analysis. Soccer heading induced mean group head accelerations of 14.49±5.4 g. Mild head impacts led to an increased NPC distance, which was supported by a significant Group x Time interaction. In the heading group, 0 h post- and 24 h post-heading NPC scores were significantly receded compared to baseline. Conversely, NPC scores for the control group showed no difference over time. Our findings indicate that mild frontal head impacts affekt NPC for a minimum of 24 h-post heading, suggesting that oculomotor processes are disrupted, at least transiently, by repetitive mild head impact.

Visual control of trunk translation and orientation during locomotion.

Previous studies have suggested distinct control of gait characteristics in the anterior-posterior (AP) and medial-lateral (ML) directions in response to visual input. Responses were larger to a ML visual stimulus, suggesting that vision plays a larger role in stabilizing gait in the ML direction. Here, we investigated responses of the trunk during locomotion to determine whether a similar direction dependence is observed. We hypothesized that translation of the trunk would show a similar ML dependence on vision, but that angular deviations of the trunk would show equivalent responses in all directions. Subjects stood or walked on a treadmill at 5 km/h while viewing a virtual wall of white triangles that moved in either the AP or ML direction according to a broadband input stimulus. Frequency response functions between the visual scene motion and trunk kinematics revealed that trunk translation gain was larger across all frequencies during walking compared with standing. Trunk orientation responses were not different from standing at very low frequencies; however, at high frequencies, trunk orientation gain was much higher during walking. Larger gains in response to ML visual scene motion were found for all trunk movements. Higher gains in the ML direction while walking suggest that visual feedback may contribute more to the stability of trunk movements in the ML direction. Vision modified trunk movement behavior on both a slow (translation) and fast (orientation) time scale suggesting a priority for minimizing angular deviations of the trunk. Overall, trunk responses to visual input were consistent with the theme that control of locomotion requires higher-level sensory input to maintain stability in the ML direction.

How visual information links to multijoint coordination during quiet standing.

The link between visual information and postural control was investigated based on a multi-degree-of-freedom model using the framework of the uncontrolled manifold (UCM) hypothesis. The hypothesis was that because visual information specifies the position of the body in space, it would couple preferentially into those combinations of degrees of freedom (DOFs) that move the body in space and not into combinations of DOFs that do not move the body in space. Subjects stood quietly in a virtual reality cave for 4-min trials with or without a 0.2, 2.0 Hz, or combined 0.2 and 2.0 Hz visual field perturbation that was below perceptual threshold. Motion analysis was used to compute six sagittal plane joint angles. Variance across time of the angular motion was partitioned into (1) variance associated with motion of the body and (2) variance reflecting the use of flexible joint combinations that keep the anterior-posterior positions of the head (HD(POS)) and center of mass (CM(POS)) invariant. UCM analysis was performed in the frequency domain in order to link the sensory perturbation to each variance component at different frequencies. As predicted, variance related to motion of the body was selectively increased at the 0.2-Hz drive frequency but not at other frequencies of sway for both CM(POS) and HD(POS). The dominant effect with the 2.0-Hz visual drive also was limited largely to variance related to motion of the body.

Motor equivalent control of the center of mass in response to support surface perturbations.

To claim that the center of mass (CM) of the body is a controlled variable of the postural system is difficult to verify experimentally. In this report, a new variant of the method of the uncontrolled manifold (UCM) hypothesis was used to evaluate CM control in response to an abrupt surface perturbation during stance. Subjects stood upright on a support surface that was displaced in the posterior direction. Support surface translations between 0.03 and 0.12 m, each lasting for 275 ms, were presented randomly. The UCM corresponding to all possible combinations of joints that are equivalent with respect to producing the average pre-perturbation anterior-posterior position of the center of mass (CM(AP)) were linearly estimated for each trial. At each point in time thereafter, the difference between the current joint configuration and the average pre-perturbation joint configuration was computed. This joint difference vector was then projected onto the pre-perturbation UCM as a measure of motor equivalence, and onto its complementary subspace, which represents joint combinations that lead to a different CM(AP) position. A similar analysis was performed related to control of the trunk's spatial orientation. The extent to which the joint velocity vector acted to stabilize the CM(AP) position was also examined. Excursions of the hip and ankle joints both increased linearly with perturbation magnitude. The configuration of joints at each instance during the perturbation differed from the mean configuration prior to the perturbation, as evidenced by the joint difference vector. Most of this joint difference vector was consistent, however, with the average pre-perturbation CM(AP) position rather than leading to a different CM(AP )position. This was not the case, however, when performing this analysis with respect to the UCM corresponding to the control of the pre-perturbation trunk orientation. The projection of the instantaneous joint velocity vector also was found to lie primarily in the UCM corresponding to the pre-perturbation CM(AP) position, indicating that joint motion was damped in directions leading to a change away from the pre-perturbation CM(AP) position. These results provide quantitative support for the argument that the CM position is a planned variable of the postural system and that its control is achieved through selective, motor equivalent changes in the joint configuration in response to support surface perturbations. The results suggest that the nervous system accomplishes postural control by a control strategy that considers all DOFs. This strategy presumably resists combinations of DOFs that affect the stability of important task-relevant variables (CM(AP) position) while, to a large extent, freeing from control combinations of those DOFs that have no effect on the task-relevant variables (Schöner in Ecol Psychol 8:291-314, 1995).

Development of somatosensory-motor integration: an event-related analysis of infant posture in the first year of independent walking.

The ability to integrate sensation with action is considered an important factor underlying the development of upright stance and locomotion. While many have studied sensory influences on posture, the nature of these influences and how they change with development have yet to be thoroughly characterized in infancy. Six infants were examined from 1 month prior to walk onset until 9 months of independent walking experience while standing quietly and touching either a static or a dynamic surface. Five adults were examined performing an analogous task. An event-related, time-frequency analysis was used to assess the relationship between postural sway and the motion of the somatosensory stimulus. Phase consistency between sway and stimulus was observed for both adults and infants, and with walking experience the infants increased their phase consistency rather than changing aspects of response amplitude. It is concluded that walking experience provides opportunities for an active tuning of sensorimotor relations for adequate estimation of body position in space and thus facilitates refined control over temporal aspects of postural sway.

The temporal organization of posture changes during the first year of independent walking.

Although the development of upright posture has received considerable attention, the quiet stance of infants in their first months of learning this fundamental behavior has not been well studied. The purpose of the present study was to characterize the time evolutionary properties, or temporal organization, of these infants' unperturbed upright stance as well as to elucidate how somatosensory information influences that organization. Six healthy, full-term infants were tested monthly from walk onset until 9 months of independent walking experience while standing either independently or touching a static surface. The structure of sway was assessed through stabilogram-diffusion analysis using an exponential Ornstein-Uhlenbeck characterization. The results of this analysis revealed two new insights into postural development. First, the developmental changes in quiet stance involved a decreased rate at which sway decays to maximal variance, rather than an attenuation of the magnitude of that variance. Specifically, measures indexing amount of sway variance were significantly reduced when touching a static surface as compared with an independent stance condition, but revealed no change with increased walking experience. Further, a reduction in the average rate constant of decay indicated an increased influence of long time-scale sway corrections on the overall sway trajectory. Second, it was shown that, at early walk ages, the use of touch both reduced the amount of variance and shifted the rate constant of sway towards longer time-scale displacements. Taken in the context of previous research, these results support our conclusion that early postural development embodies the dual tasks of calibrating sensorimotor relations for estimation of self-motion as well as identification and tuning of control system properties.

Human multisensory fusion of vision and touch: detecting non-linearity with small changes in the sensory environment.

Previous investigations using relatively large amplitude sensory stimuli or complete removal of sensory input have demonstrated non-linear processing of sensory information for postural control. In the present study, we asked whether a linear range of sensory fusion exists when smaller amplitude stimuli are used. The amplitudes of visual and somatosensory input were simultaneously co-varied within a trial. The postural responses were characterized by analyzing how the Fourier transform of postural sway at the driving frequency varied with sensory movement amplitudes. If the postural control system is linear with constant weighting of sensory inputs, then the pattern of Fourier transforms should be a linear function of movement amplitude. However, in 28 of 58 trials we observed non-linearity in this function. The results clearly show that even at very small amplitudes of sensory change, the nervous system processes multisensory information in a non-linear fashion.

Multisensory information for human postural control: integrating touch and vision.

Despite extensive research on the influence of visual, vestibular and somatosensory information on human postural control, it remains unclear how these sensory channels are fused for self-orientation. The focus of the present study was to test whether a linear additive model could account for the fusion of touch and vision for postural control. We simultaneously manipulated visual and somatosensory (touch) stimuli in five conditions of single- and multisensory stimulation. The visual stimulus was a display of random dots projected onto a screen in front of the standing subject. The somatosensory stimulus was a rigid plate which subjects contacted lightly (<1 N of force) with their right index fingertip. In each condition, one sensory stimulus oscillated (dynamic) in the medial-lateral direction while the other stimulus was either dynamic, static or absent. The results qualitatively supported five predictions of the linear additive model in that the patterns of gain and variability across conditions were consistent with model predictions. However, a strict quantitative comparison revealed significant deviations from model predictions, indicating that the sensory fusion process clearly has nonlinear aspects. We suggest that the sensory fusion process behaved in an approximately linear fashion because the experimental paradigm tested postural control very close to the equilibrium point of vertical upright.

Precision contact of the fingertip reduces postural sway of individuals with bilateral vestibular loss.

Contact of the hand with a stationary surface attenuates postural sway in normal individuals even when the level of force applied is mechanically inadequate to dampen body motion. We studied whether subjects without vestibular function would be able to substitute contact cues from the hand for their lost labyrinthine function and be able to balance as well as normal subjects in the dark without finger contact. We also studied the relative contribution of sight of the test chamber to the two groups. Subjects attempted to maintain a tandem Romberg stance for 25 s under three levels of fingertip contact: no contact; light-touch contact, up to 1 N (approximately 100 g) force; and unrestricted contact force. Both eyes open and eyes closed conditions were evaluated. Without contact, none of the vestibular loss subjects could stand for more than a few seconds in the dark without falling; all the normals could. The vestibular loss subjects were significantly more stable in the dark with light touch of the index finger than the normal subjects in the dark without touch. They also swayed less in the dark with light touch than when permitted sight of the test chamber without touch, and less with sight and touch than just sight. The normal subjects swayed less in the dark with touch than without, and less with sight and touch than sight alone. These findings show that during quiet stance light touch of the index finger with a stationary surface can be as effective or even more so than vestibular function for minimizing postural sway.

The structure of somatosensory information for human postural control.

The goal of the present study was to determine the properties of the somatosensory stimulus that alter its temporal coupling to body sway. Six standing subjects were tested while touching a metal plate positioned either directly in front of or lateral to the subject. In each condition, the plate moved 4 mm at 0.2 Hz in either the medial-lateral (ML) or anterior-posterior direction (AP). The results showed that coupling between body sway and touch plate movement was strongest when the touch plate moved in a direction along the longitudinal axis of the arm. Coupling strength was weaker when the touch plate moved perpendicular to the longitudinal axis of the arm. The results consistently show that a radial expansion stimulus was more effective than a lamellar-type stimulus at the fingertip. Moreover, somatosensory information from a surface is interpreted in terms of the orientation of the contact limb and the potential degrees of freedom available through its movement.

Position and velocity coupling of postural sway to somatosensory drive.

Light touch contact of a fingertip to a stationary surface provides orientation information that enhances control of upright stance. Slight changes in contact force at the fingertip lead to sensory cues about the direction of body sway, allowing attenuation of sway. In the present study, the coupling of postural sway to a moving contact surface was investigated in detail. Head, center of mass, and center of pressure displacement were measured as the contact surface moved rhythmically at 0.1, 0.2, 0.4, 0.6, and 0.8 Hz. Stimulus amplitude decreased with frequency to maintain peak velocity constant across frequency. Head and body sway were highly coherent with contact surface motion at all frequencies except 0.8 Hz, where a drop-off in coherence was observed. Mean frequency of head and body sway matched the driving frequency

Light touch contact as a balance aid.

Canes and crutches are commonly used mobility aids, and most studies of their use have focused on issues equating support with the resulting decrease in force required of the affected limb. Clinicians, however, often observe patients with poor balance control using light touch of surrounding objects and surfaces to stabilize themselves while standing and walking. A series of studies have shown that sensory input to the hand and arm through contact cues at the fingertip or through a cane can reduce postural sway in individuals who have no impairments and in patients without a functioning vestibular system, even when contact force levels are inadequate to provide physical support of the body. This article summarizes these results, which have implications for design considerations of rehabilitation aids. Mobility devices or rehabilitation aids that provide feedback about applied force or enhance existing resolution of applied force changes across the skin surface may lead to new rehabilitation techniques.

Coupling of fingertip somatosensory information to head and body sway.

Light touch contact of a fingertip with a stationary surface can provide orientation information that enhances control of upright stance. Slight changes in contact force at the fingertip provide sensory cues about the direction of body sway, allowing attenuation of sway. In the present study, we asked to which extent somatosensory cues are part of the postural control system, that is, which sensory signal supports this coupling? We investigated postural control not only when the contact surface was stationary, but also when it was moving rhythmically (from 0.1 to 0.5 Hz). In doing so, we brought somatosensory cues from the hand into conflict with other parts of the postural control system. Our focus was the temporal relationship between body sway and the contact surface. Postural sway was highly coherent with contact surface motion. Head and body sway assumed the frequency of the moving contact surface at all test frequencies. To account for these results, a simple model was formulated by approximating the postural control system as a second-order linear dynamical system. The influence of the touch stimulus was captured as the difference between the velocity of the contact surface and the velocity of body sway, multiplied by a coupling constant. Comparison of empirical results (relative phase, coherence, and gain) with model predictions supports the hypothesis of coupling between body sway and touch cues through the velocity of the somatosensory stimulus at the fingertip. One subject, who perceived movement of the touch surface, demonstrated weaker coupling than other subjects, suggesting that cognitive mechanisms introduce flexibility into the postural control scheme.

Haptic cues for orientation and postural control in sighted and blind individuals.

Haptic cues from fingertip contact with a stable surface attenuate body sway in subjects even when the contact forces are too small to provide physical support of the body. We investigated how haptic cues derived from contact of a cane with a stationary surface at low force levels aids postural control in sighted and congenitally blind individuals. Five sighted (eyes closed) and five congenitally blind subjects maintained a tandem Romberg stance in five conditions: (1) no cane; (2,3) touch contact (< 2 N of applied force) while holding the cane in a vertical or slanted orientation; and (4,5) force contact (as much force as desired) in the vertical and slanted orientations. Touch contact of a cane at force levels below those necessary to provide significant physical stabilization was as effective as force contact in reducing postural sway in all subjects, compared to the no-cane condition. A slanted cane was far more effective in reducing postural sway than was a perpendicular cane. Cane use also decreased head displacement of sighted subjects far more than that of blind subjects. These results suggest that head movement control is linked to postural control through gaze stabilization reflexes in sighted subjects; such reflexes are absent in congenitally blind individuals and may account for their higher levels of head displacement.

Manipulating symmetry in the coordination dynamics of human movement.

J. A. S. Kelso and J. J. Jeka (1992) demonstrated that symmetry is a useful conceptual tool to distinguish the coordination between components with similar versus different anatomical properties. The present experiments studied human arm-leg patterns to test whether their coordinative asymmetry was changed by manipulating the inertial properties of a single limb. The results showed that (a) consistent with model predictions, adding weight to the arm or the leg minimized or enhanced coordinative asymmetry, respectively and (b) the response to a perturbation slowed as movement frequency increased but in a fashion that reflected the underlying coordinative asymmetry. The observed coordinative effects suggest the influence of neural phase relationships and emphasize that symmetry plays an important role in understanding coordination in systems in which control cannot be traced unequivocally to a single end-effector or a neurophysiological substrate.

The role of haptic cues from rough and slippery surfaces in human postural control.

Haptic information is critically important in complex sensory-motor tasks such as manipulating objects. Its comparable importance in spatial orientation is only beginning to be recognized. We have shown that postural sway in humans is significantly reduced by lightly touching a stable surface with a fingertip at contact force levels far below those physically necessary to stabilize the body. To investigate further the functional relationship between contact forces at the hand and postural equilibrium, we had subjects stand in the tandem Romberg stance while being allowed physically supportive (force contact) and non-physically supportive (touch contact) amounts of index fingertip force on surfaces with different frictional characteristics. Mean sway amplitude (MSA) was reduced by over 50% with both touch and force contact of the fingertip, compared to standing without fingertip contact. No differences in MSA were observed when touching rough or slippery surfaces. The amplitude of EMG activity in the peroneal muscles and the timing relationships between fingertip forces, body sway and EMG activity suggested that with touch contact of the finger or with force contact on a slippery surface long-loop "reflexes" involving postural muscles were stabilizing sway. With force contact of the fingertip on a rough surface, MSA reduction was achieved primarily through physical support of the body. This pattern of results indicates that light touch contact cues from the fingertip in conjunction with proprioceptive signals about arm configuration are providing information about body sway that can be used to reduce MSA through postural muscle activation.

Fingertip contact influences human postural control.

Touch and pressure stimulation of the body surface can strongly influence apparent body orientation, as well as the maintenance of upright posture during quiet stance. In the present study, we investigated the relationship between postural sway and contact forces at the fingertip while subjects touched a rigid metal bar. Subjects were tested in the tandem Romberg stance with eyes open or closed under three conditions of fingertip contact: no contact, touch contact (< 0.98 N of force), and force contact (as much force as desired). Touch contact was as effective as force contact or sight of the surroundings in reducing postural sway when compared to the no contact, eyes closed condition. Body sway and fingertip forces were essentially in phase with force contact, suggesting that fingertip contact forces are physically counteracting body sway. Time delays between body sway and fingertip forces were much larger with light touch contact, suggesting that the fingertip is providing information that allows anticipatory innervation of musculature to reduce body sway. The results are related to observations on precision grip as well as the somatosensory, proprioceptive, and motor mechanisms involved in the reduction of body sway.

Pattern switching in human multilimb coordination dynamics.

A relative phase model of four coupled oscillators is used to interpret experiments on the coordination between rhythmically moving human limbs. The pairwise coupling functions in the model are motivated by experiments on two-limb coordination. Stable patterns of coordination between the limbs are represented by fixed points in relative phase coordinates. Four invariant circles exist in the model, each containing two patterns of coordination seen experimentally. The direction of switches between two four-limb patterns on the same circle can be understood in terms of two-limb coordination. Transitions between patterns in the human four-limb system are theoretically interpreted as bifurcations in a nonlinear dynamical system.

Symmetry breaking dynamics of human multilimb coordination.

The dynamics of pattern formation and change are studied in a complex multicomponent system, specifically the arms and legs of human Ss. Among the novel features observed are differential stability of coordinative modes produced by limbs moving in the same versus different directions (Experiment 1); transitions between coordinative modes preceded by a slow drift in relative phase (Experiments 1 and 2); bifurcations or phase transitions from 1 four-limb pattern to another (Experiment 2); and spontaneous emergence of non-1:1-frequency- and phase-locked patterns, in addition to periods of relative coordination (Experiment 3). All observed relative phasing patterns and their dynamics (stability, loss of stability, intermittency) are shown to arise from the same underlying nonlinear dynamical structure, an important feature of which is broken symmetry.