Effects of experimentally induced cervical spine mobility alteration on the postural organisation of gait initiation.

Gait initiation (GI), the transient period between quiet standing and locomotion, is a functional task classically used in the literature to investigate postural control. This study aimed to investigate the influence of an experimentally-induced alteration of cervical spine mobility (CSM) on GI postural organisation. Fifteen healthy young adults initiated gait on a force-plate in (1) two test conditions, where participants wore a neck orthosis that passively simulated low and high levels of CSM alteration; (2) one control condition, where participants wore no orthosis; and (3) one placebo condition, where participants wore a cervical bandage that did not limit CSM. Centre-of-pressure and centre-of-mass kinematics were computed based on force-plate recordings according to Newton's second law. Main results showed that anticipatory postural adjustments amplitude (peak backward centre-of-pressure shift and forward centre-of-mass velocity at toe-off) and motor performance (step length and forward centre-of-mass velocity at foot-contact) were altered under the condition of high CSM restriction. These effects of CSM restriction may reflect the implementation of a more cautious strategy directed to attenuate head-in-space destabilisation and ease postural control. It follows that clinicians should be aware that the prescription of a rigid neck orthosis to posturo-deficient patients could exacerbate pre-existing GI deficits.

Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation.

Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.

Comparison of base of support size during gait initiation using force-plate and motion-capture system: A Bland and Altman analysis.

This study aimed to estimate the error made by investigators when force-plate data are used to approximate base of support size during gait initiation. Step length and step width obtained with a method based on motion capture system (Kinematics method, considered the "gold standard") and with a method based on the centre of pressure traces obtained from a force-plate (Force-plate method) were purposely compared using descriptive statistics and the Bland and Altman (BA) method. Participants (N=19) performed series of gait initiation in Spontaneous and Maximal Velocity Conditions (SVC and MVC, respectively). BA analysis showed that 1) step length and width biases, corresponding to the difference between the two methods, were very small (<2.1%) in both velocity conditions and 2) the 95% limits of agreement of the BA plots ranged between 10% and 15% in absolute value. Repeated measures ANOVA showed that step length was significantly larger in MVC than in SVC, with no velocity X method interaction. There was no significant effect of the method on both step parameters. The present results suggest that the Force-plate method is sufficiently accurate to compare step parameters across conditions. However, researchers should be aware that non-negligible errors might occur when considering individual data.

Detection of swing heel-off event in gait initiation using force-plate data.

This study investigated the accuracy and reliability of four methods using force-plate data for detecting the swing heel-off (HO) time in gait initiation. Results of these methods were compared to those obtained by means of a reference method using a footswitch. Ten young healthy adults performed 18 forward gait initiation trials at self-selected speed and at maximal speed. Results showed that the method based on vertical impulse was the most accurate and reliable in determining HO in both speed conditions. The mean error obtained with this method was -8±10ms in the self-selected speed condition (-7±10ms in the maximal speed condition), with no significant effect of gait speed (P>0.05). These findings suggest that this method based on force-plate data is valid and reliable for detecting HO in forward gait initiation in the absence of additional hardware.

Influence of temporal pressure on anticipatory postural control of medio-lateral stability during rapid leg flexion.

During leg flexion from erect posture, postural stability along the medio-lateral direction is organized in advance during "anticipatory postural adjustments" (APAs). This study aimed to investigate the influence of temporal pressure on this anticipatory postural control of medio-lateral stability. Eight young healthy participants performed series of leg flexions (1) as soon as possible in response to an acoustic signal (reaction-time condition; condition with temporal pressure) and (2) in a self-initiated condition (no temporal pressure). Results showed that APAs duration was shorter in the reaction-time condition as compared to the self-initiated condition; this shortening was compensated by an increase in the medio-lateral center-of-pressure displacement so that the dynamic stability reached at foot-off, as measured by the "extrapolated center-of-mass", remained unchanged. It is concluded that when a complex task is performed under temporal pressure, the central nervous system is able to modulate the spatio-temporal features of APAs in a way to both hasten the initiation of the voluntary movement and maintain optimal conditions of dynamic stability. In other words, it seems that the central nervous system does not "trade off optimal stability for speed of movement initiation under reaction-time condition", as it had been proposed in the literature.

Biomechanical reorganisation of stepping initiation during acute dorsiflexor fatigue.

During voluntary step initiation (SI), propulsive forces are generated during anticipatory postural adjustments (APA) which displace the centre-of-gravity (CoG) in the desired direction. These propulsive forces are implemented by ankle synergy, bilateral soleus inhibition followed by activation of tibialis anterior (TA). The aim of this study was to investigate the effect of fatigue applied to ankle dorsiflexors on APA associated with SI and on related motor performance. Eight young healthy participants initiated stepping before and after a protocol designed to generate fatigue in ankle dorsiflexors. Fatigue was induced by series of high-level isometric contractions performed until exhaustion. Results showed that, with fatigue, the level of TA activation during APA, anticipatory postural dynamics (backward centre-of-pressure displacement and forward CoG velocity) and related motor performance (peak of CoG velocity) were attenuated, while APA duration and total SI duration increased. These changes were interpreted as reflecting a protective strategy aiming to preserve the integrity of the fatigued muscles, rather than an impairment associated with muscle weakness.

Influence of fear of falling on anticipatory postural control of medio-lateral stability during rapid leg flexion.

During leg flexion from erect posture, postural stability is organized in advance during "anticipatory postural adjustments" (APA). During these APA, inertial forces are generated that propel the centre of gravity (CoG) laterally towards stance leg side. This study examined how fear of falling (FoF) may influence this anticipatory postural control of medio-lateral (ML) stability. Ten young healthy participants performed a series of leg flexions at maximal velocity from low and high surface heights (6 and 66 cm above ground, respectively). In this latter condition with increased FoF, stance foot was placed at the lateral edge of the support surface to induce maximal postural threat. Results showed that the amplitude of ML inertial forces generated during APA decreased with FoF; this decrease was compensated by an increase in APA duration so that the CoG position at time of swing foot-off was located further towards stance leg side. With these changes in ML APA, the CoG was propelled in the same final (unipodal) position above stance foot as in condition with low FoF. These results contrast with those obtained in the literature during quiet standing which showed that FoF did not have any influence on the ML component of postural control. It is proposed that ML APA are modified with increased FoF, in such a way that the risk of a sideway fall induced by the large CoG motion is attenuated.

Effect of lower limb muscle fatigue on anticipatory postural adjustments associated with bilateral-forward reach in the unipedal dominant and non-dominant stance.

Voluntary arm movements are preceded by dynamical and electromyographical (EMG) phenomena in "postural segments" (i.e. body segments not directly involved in the voluntary movement) called "anticipatory postural adjustments" (APA). The present study examined how the central nervous system organizes APA under fatigued state of postural musculature elicited by series of high-level isometric contractions (HIC), i.e. corresponding to 60% of maximal voluntary contraction. Subjects (N = 14) purposely performed series of bilateral-forward reach task (BFR) under unipodal stance (dominant and non-dominant) before ("no fatigue" condition, NF) and after ("fatigue" condition, F) a procedure designed to obtain major fatigue in hamstrings. Centre-of-gravity acceleration, centre-of-pressure displacement, and electrical activity of trunk and leg muscles were recorded and quantified within a time-window typical of APA. Results showed that there was no significant effect of fatigue on the level of muscle excitation and APA onset in any of the postural muscles recorded. Similarly, no change in APA onset could be detected from the biomechanical traces. In contrast, results showed that the amplitude of anticipatory centre-of-pressure displacement and centre-of-gravity acceleration reached lower value in F than in NF. Similar results were obtained whether dominant or non-dominant leg was considered. The changes in biomechanical APA features could not be ascribed to a different focal movement performance (maximal BFR velocity and acceleration) between F and NF. These results suggest that, when fatigue is induced by HIC, the capacity of the central nervous system to adapt APA programming to the fatigued state of the postural muscle system might be altered.

Control of mediolateral stability during rapid step initiation with preferred and non-preferred leg: is it symmetrical?

During voluntary stepping initiation, postural stability along the mediolateral direction is controlled via "anticipatory postural adjustment" (APA). This study tested the hypothesis that, in young healthy subjects, the biomechanical features of mediolateral APA depend on the leg that initiates stepping. Subjects (N=10) initiated a rapid single step with the preferred (P condition) and the non-preferred leg (NP condition) on a force-plate. Results showed that mediolateral APA duration (P=0.020) and amplitude were higher (as attested by the increase in maximal center-of-gravity velocity (P=0.003) and displacement (P<0.001) during APA), and that mediolateral stability was better (as attested by the attenuation in center-of-gravity velocity at time of swing-foot contact (P=0.007)) in P than in NP. These results support the view that stepping initiation in healthy subjects involves postural asymmetry. This statement may have relevant implications in clinical evaluation where postural asymmetry is generally considered as reflecting postural impairment.

Does symmetrical upper limb task involve symmetrical postural adjustments?

This study tested the hypothesis that, in young healthy subjects, a symmetrical upper limb task involves asymmetrical postural adjustments with respect to lower limb dominance. Subjects (N=10) purposely performed a series of bilateral forward-reach tasks (BFR) while standing unilaterally on the dominant leg, on the non-dominant leg (unilateral conditions) or on both legs (bipedal condition). For each leg, the integrated electromyographical (iEMG) activity per 20-ms periods ranging from 300 ms before BFR onset (t0) to 1000 ms after t0 was compared between the unipedal and bipedal stance conditions. This time-window included "anticipatory", "on-line" and "corrective" postural adjustments, i.e. those postural adjustments occurring before (anticipatory postural adjustments, APAs), during (on-line postural adjustments, OPAs) and after (corrective postural adjustments, CPAs) the BFR. During the APAs, results showed that, for each leg, changing the stance condition from bipedal to unipedal did not elicit any iEMG changes in any of the postural muscles investigated. In contrast, during the OPAs, an early increase in the excitation level of the semitendinosus for the dominant leg and a late increase in the excitation level of the soleus for the non-dominant leg were detected. During the CPAs, an increase in the excitation level of the soleus, tibialis anterior and semitendinosus was detected in the non-dominant leg whereas, in the dominant leg, no change in the excitation level for any postural muscle recorded was observed. These results support the concept of side dominance in the postural component of a symmetrical upper limb task.

Effect of lower limb muscle fatigue induced by high-level isometric contractions on postural maintenance and postural adjustments associated with bilateral forward-reach task.

This study tested the effect of lower limb muscle fatigue induced by series of high-level isometric contractions (IC) on postural adjustments and maintenance of erect posture. Subjects (N=7) displaced a bar (grasp-bar) forward with both hands at maximal velocity towards a target ("bilateral forward-reach" task, BFR), before and after a procedure designed to induce fatigue in dorsal leg muscles. This procedure included IC at 60% of maximum. Postural joint and grasp-bar motion, along with electrical activity of postural and focal muscles were recorded. Integrated electromyographical (EMG) activity per 20 ms period ranging from 400 ms before BFR onset (t0) to 400 ms after t0 was compared before and after the fatiguing procedure. This time-window included "anticipatory", "on-line" and "corrective" postural adjustments, i.e. those postural adjustments occurring before (APAs), during (OPAs) and after (CPAs) BFR, respectively. In contrast to the literature, results showed that the fatiguing procedure had no effect on muscle excitation or timing in any of the recorded postural muscles, regardless of APA, OPA or CPA-related time-window. Therefore, the postural drive did not change with fatigue. Furthermore, the peak-to-peak motion at postural joints did not change. Postural maintenance was therefore not additionally challenged. These results are in line with the hypothesis that the effect of fatigue on postural adjustments is dependent on the adequacy between fatigued motor units (MUs) and MUs recruited during the postural adjustments. Increasing IC intensity during the fatiguing procedure might therefore not necessarily exacerbate the effect of fatigue on postural control highlighted during lower level IC.

In a complex sequential movement, what component of the motor program is improved with intensive practice, sequence timing or ensemble motor learning?

We investigated whether the higher maximum speed of complex athletic movements attained by experts compared with novices might solely be ascribed to the acquisition of a more efficient timing of the initiation of the simple movements that comprise complex sporting gestures. Six novices in fencing and five experts in fencing performed three experimental series: 7 trials of touche, 7 trials of lunge (control series) and 50 trials of lunge + touche (test series), where the touche and lunge were initiated with different chronological sequences imposed by the experimenter. The lunge and the touche can be assimilated to a fast forward step and to a pointing task, respectively. We compared the maximum speed of touche between the two groups, recorded by an accelerometer fixed to the hand guard of the foil, and the speed of the centre of mass obtained from a force plate. The speed of the centre of mass was not statistically different between the two groups in the control and in the test series. The maximum speed of touche was not statistically different between the two groups in the control series. In contrast, in the test series, the maximum speed of touche was higher in the fencers' than in novices' groups, while the timing of initiation of the lunge and the touche was similar. The results of the test series show that the higher maximum speed of touche of fencers compared with novices cannot solely be ascribed to the acquisition of a more efficient initiation timing in motor programming. In a complex fencing gesture, the higher maximum speed of touche following intensive practice is discussed with regard to the inhibition of negative effects linked to the "refractory period" associated with the initiation of two closely spaced motor programs.

In fencing, does intensive practice equally improve the speed performance of the touche when it is performed alone and in combination with the lunge?

Global movements are generally composed of several simple movements. In this study we tested the hypothesis that the effects of practice on the performance of a simple movement cannot be highlighted when it is performed alone but only when it is part of a global movement. For this purpose we examined the performance of the touche movement in fencing, in terms of maximal speed of the foil, when it is performed alone and in combination with the lunge. The touche can be assimilated to a pointing task towards a target while the lunge can be assimilated to a forward stepping movement. Four international class fencers and five novices were tested. The results show that 1) the performance in the isolated touche condition was comparable between the two test populations, 2) the performance was higher in the expert population compared to the novice population in the sequential touche + lunge condition, and 3) the velocity of the centre of mass at the time of the peak velocity of the touche was higher in the expert population than in the novice population in the sequential touche + lunge condition. In line with Bernstein's concepts on the effects of practice on motor control it is suggested that the experts exploit to advantage the forces developed during the lunge whereas the novices do not.

Do centrally programmed anticipatory postural adjustments in fast stepping affect performance of an associated "touche" movement?

Ensuring maximum speed in executing a sequence of two voluntary movements requires the second movement to be triggered only after some delay. This is due to the existence of a "relative refractory period." If the second movement is initiated during the refractory period, its speed decreases (movement time increases). In the present study we tested the existence of a refractory period during the execution of a sequence of movements involving both the upper and the lower limbs. More precisely, we examined whether the maximal speed of the touche fencing movement is affected by the anticipatory postural adjustments (APA) preceding a voluntary lunge. The touche and the lunge are similar to a pointing task and a stepping forward movement, respectively. touche consists of hitting a target with a foil at maximal velocity. The results show that (a) when the touche was initiated prior to the onset of the APA of the lunge, the maximal foil velocity remains similar to that of an isolated touche, and (b) when the touche is initiated during the development of the APA of the lunge, the maximal foil velocity is lower than in the isolated touche. Furthermore, the maximal foil velocity decreases with the temporal progression of the APA and reaches its minimal value when initiated at the time of voluntary lunge execution ('foot off'). The discussion suggests that the centrally programmed APA that are elicited in the stepping forward movement induces a refractory period which affects performance of the pointing task.