Postural control deficits due to bilateral pyramidal tract lesions exemplified by hereditary spastic paraplegia (HSP) originate from increased feedback time delay and reduced long-term error corrections.

Pyramidal tract lesions determine the clinical syndrome of Hereditary Spastic Paraplegia (HSP). The clinical impairments of HSP are typically exemplified by their deficits in mobility, leading to falls and injuries. The first aim of this study was to identify the cause for postural abnormalities caused by pyramidal tract lesions in HSP. The second aim was to specify the effect of treadmill training for postural abnormalities. We examined nine HSP patients before and after treadmill training, as well as nine healthy control subjects during perturbed and unperturbed stance. We found that HSP was associated with larger sway amplitudes and velocities. Body excursions following platform tilts were larger, and upper body excursions showed a phase lead. Model-based analysis detected a greater time delay and a reduced long-term error correction of postural reactions in the center of mass. HSP patients performed significantly better in clinical assessments after treadmill training. In addition, treadmill training reduced sway amplitudes and body excursions, most likely by increasing positional and velocity error correction gain as a compensatory mechanism, while the time delay and long-term error correction gain remained largely unaffected. Moreover, the upper body's phase lead was reduced. We conclude that HSP leads to very specific postural impairments. While postural control generally benefits from treadmill training, the effect seems to mainly rely on compensatory mechanisms, whereas the original deficits are not affected significantly.

A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention.

BACKGROUND: Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). However, knowledge about postural behavior of CIPN patients is sparse. With this pilot study, we used a new approach to i) characterize postural impairments as compared to healthy subjects, ii) allocate possible abnormalities to a set of parameters describing sensorimotor function, and iii) evaluate the effects of a balance-based exercise intervention. METHODS: We analyzed spontaneous and externally perturbed postural control in eight CIPN patients before and after a balance-based exercise intervention by using a modification of an established postural control model. These findings were compared to 15 matched healthy subjects. RESULTS: Spontaneous sway amplitude and velocity were larger in CIPN patients compared to healthy subjects. CIPN patients' reactions to external perturbations were smaller compared to healthy subjects, indicating that patients favor vestibular over proprioceptive sensory information. The balance-based exercise intervention up-weighted proprioceptive information in patients. CONCLUSIONS: CIPN patients' major postural deficit may relate to underuse of proprioceptive information that results in a less accurate posture control as spontaneous sway results indicate. The balance-based exercise intervention is able to partially correct for this abnormality. Our study contributes to a better understanding of postural impairments in CIPN patients and suggests an effective treatment strategy. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00004340, retrospectively registered 04 January 2013.

Abnormal trunk control determines postural abnormalities in Amyotrophic Lateral Sclerosis.

BACKGROUND: Postural instability in Amyotrophic Lateral Sclerosis (ALS) occurs at an early stage of the disease and often results in falls. As ALS is considered a multisystem neurodegenerative disorder, postural instability may result from motor, sensory and central processing deficits. OBJECTIVE AND METHODS: We analysed postural control of 12 ALS patients and 12 healthy age-matched control subjects. Postural control was characterised by spontaneous sway measures and measures of postural reactions to pseudorandom anterior-posterior platform tilts, which were then correlated with clinical test scores. RESULTS: Spontaneous sway amplitudes and velocities were significantly larger and sway frequencies higher in ALS patients than in control subjects. ALS patients' body excursions following platform tilts were smaller, with relatively higher upper body excursions. We found high correlations between abnormal postural reactions and clinical tests representing motor or balance deficits. CONCLUSIONS: We conclude that ALS patients' postural abnormalities are mainly determined by an abnormal axial control and abnormally small body excursions as a function of support surface tilts, seemingly indicating better postural stabilization than control subjects. The latter contradicts the hypothesis that muscle weakness is the main source for this deficit. Instead, we suggest an altered central control strategy.

Postural instability in adult ADHD - A pilot study.

BACKGROUND: Apart from inattention, hyperactivity and impulsivity, ADHD in childhood presents with an impairment of motor coordination and balance functions. Until now, literature is scarce about sensorimotor deficits in adult ADHD. This is a pilot study that identifies and quantifies the role of sensory, motor, and central adaptation mechanisms for adult ADHD patients' sensorimotor deficits in a systematic way, using postural control. METHODS: We analyzed spontaneous and externally perturbed stance in ten adult patients suffering from ADHD. Findings were compared to data from ten matched healthy subjects. RESULTS: Spontaneous sway amplitudes and velocities were larger in ADHD patients compared to healthy subjects. Furthermore, body excursions as a function of platform tilts were abnormally large in ADHD patients, specifically in the low frequency range. Based on simple feedback model simulations, we found that ADHD patients showed a larger time delay between platform tilts and body response, and a lower value of the integral part of the neural controller, which affects the long-term control of their posture. These postural abnormalities correlated well with the hyperactivity and impulsivity dimensions of the individual ADHD symptoms. CONCLUSION: We conclude that adult ADHD patients' major postural deficit consists of an impairment of a stable, long-term sensorimotor behavior, which fits very well to the concept of impulsivity and hyperactivity.

Motion Biomarkers Showing Maximum Contrast Between Healthy Subjects and Parkinson's Disease Patients Treated With Deep Brain Stimulation of the Subthalamic Nucleus. A Pilot Study.

Background: Classic motion abnormalities in Parkinson's disease (PD), such as tremor, bradykinesia, or rigidity, are well-covered by standard clinical assessments such as the Unified Parkinson's Disease Rating Scale (UPDRS). However, PD includes motor abnormalities beyond the symptoms and signs as measured by UPDRS, such as the lack of anticipatory adjustments or compromised movement smoothness, which are difficult to assess clinically. Moreover, PD may entail motor abnormalities not yet known. All these abnormalities are quantifiable via motion capture and may serve as biomarkers to diagnose and monitor PD. Objective: In this pilot study, we attempted to identify motion features revealing maximum contrast between healthy subjects and PD patients with deep brain stimulation (DBS) of the nucleus subthalamicus (STN) switched off and on as the first step to develop biomarkers for detecting and monitoring PD patients' motor symptoms. Methods: We performed 3D gait analysis in 7 out of 26 PD patients with DBS switched off and on, and in 25 healthy control subjects. We computed feature values for each stride, related to 22 body segments, four time derivatives, left-right mean vs. difference, and mean vs. variance across stride time. We then ranked the feature values according to their distinguishing power between PD patients and healthy subjects. Results: The foot and lower leg segments proved better in classifying motor anomalies than any other segment. Higher degrees of time derivatives were superior to lower degrees (jerk > acceleration > velocity > displacement). The averaged movements across left and right demonstrated greater distinguishing power than left-right asymmetries. The variability of motion was superior to motion's absolute values. Conclusions: This small pilot study identified the variability of a smoothness measure, i.e., jerk of the foot, as the optimal signal to separate healthy subjects' from PD patients' gait. This biomarker is invisible to clinicians' naked eye and is therefore not included in current motor assessments such as the UPDRS. We therefore recommend that more extensive investigations be conducted to identify the most powerful biomarkers to characterize motor abnormalities in PD. Future studies may challenge the composition of traditional assessments such as the UPDRS.

Correlations between Motor Symptoms across Different Motor Tasks, Quantified via Random Forest Feature Classification in Parkinson's Disease.

BACKGROUND: Objective assessments of Parkinson's disease (PD) patients' motor state using motion capture techniques are still rarely used in clinical practice, even though they may improve clinical management. One major obstacle relates to the large dimensionality of motor abnormalities in PD. We aimed to extract global motor performance measures covering different everyday motor tasks, as a function of a clinical intervention, i.e., deep brain stimulation (DBS) of the subthalamic nucleus. METHODS: We followed a data-driven, machine-learning approach and propose performance measures that employ Random Forests with probability distributions. We applied this method to 14 PD patients with DBS switched-off or -on, and 26 healthy control subjects performing the Timed Up and Go Test (TUG), the Functional Reach Test (FRT), a hand coordination task, walking 10-m straight, and a 90° curve. RESULTS: For each motor task, a Random Forest identified a specific set of metrics that optimally separated PD off DBS from healthy subjects. We noted the highest accuracy (94.6%) for standing up. This corresponded to a sensitivity of 91.5% to detect a PD patient off DBS, and a specificity of 97.2% representing the rate of correctly identified healthy subjects. We then calculated performance measures based on these sets of metrics and applied those results to characterize symptom severity in different motor tasks. Task-specific symptom severity measures correlated significantly with each other and with the Unified Parkinson's Disease Rating Scale (UPDRS, part III, correlation of r2 = 0.79). Agreement rates between different measures ranged from 79.8 to 89.3%. CONCLUSION: The close correlation of PD patients' various motor abnormalities quantified by different, task-specific severity measures suggests that these abnormalities are only facets of the underlying one-dimensional severity of motor deficits. The identification and characterization of this underlying motor deficit may help to optimize therapeutic interventions, e.g., to "automatically" adapt DBS settings in PD patients.

Elderly Use Proprioception Rather than Visual and Vestibular Cues for Postural Motor Control.

Multiple factors have been proposed to contribute to the deficits of postural control in the elderly. They were summarized as sensory, motor, and higher-level adaptation deficits. Using a model-based approach, we aimed to identify which of these deficits mainly determine age-related changes in postural control. We analyzed postural control of 20 healthy elderly people with a mean age of 74 years. The findings were compared to data from 19 healthy young volunteers (mean age 28 years) and 16 healthy middle-aged volunteers (mean age 48 years). Postural control was characterized by spontaneous sway measures and measures of perturbed stance. Perturbations were induced by pseudorandom anterior-posterior tilts of the body support surface. We found that spontaneous sway amplitude and velocity were significantly larger, and sway frequencies were higher in elderly compared to young people. Body excursions as a function of tilt stimuli were clearly different in elderly compared to young people. Based on simple feedback model simulations, we found that elderly favor proprioceptive over visual and vestibular cues, other than younger subjects do. Moreover, we identified an increase in overall time delay challenging the feedback systems stability, and a decline in the amplitude of the motor feedback, probably representing weakness of the motor system. In general, these parameter differences between young and old may result from both deficits and compensation strategies in the elderly. Our model-based findings correlate well with deficits measured with clinical balance scores, which are widely used in clinical practice.