Effect of age on anticipatory postural adjustments in unilateral arm movement.

Aging is frequently accompanied by a deterioration in postural control. Accordingly, the elderly adopt postural strategies in order to maintain balance. The purpose of this study was to compare anticipatory postural adjustments in (healthy) 10 young and 10 elderly subjects using electromyography (EMG) and biomechanical parameters. While standing on a force platform, subjects performed voluntary, arm-raising movements under five conditions: self-paced at three different velocities, self-paced with load and an externally triggered, both at maximal velocity. The force platform provided information on vertical torque (T(z)) and center of pressure anteroposterior displacements (COP). EMG activity was recorded from the biceps femoris, quadriceps, tibialis anterior and soleus muscles. Voluntary movements were associated with an early COP backward shift and an anticipatory T(z). At low velocity, elderly subjects did not show any impairment in stability. At maximal velocity, T(z) was delayed in all conditions in the elderly group, whereas COP latency was reduced only in the self-paced condition without load. Despite this decrease in anticipation, the movement was performed at the same velocity as in younger subjects. The elderly adopted various muscle strategies in order to perform the same movement with less stability. In the self-paced condition, elderly subjects used a hip strategy, whereas young subjects used an ankle strategy. In the triggered condition, the strategy corresponded to increased activation of certain thigh muscles, rather than a sequence modification. Hence, local muscle strategies were used to counteract the overall delay in postural preparation revealed by biomechanical parameters.

Vertical torque allows recording of anticipatory postural adjustments associated with slow, arm-raising movements.

BACKGROUND: When performed in the upright position, voluntary arm-raising movements perturb balance. The maintenance of equilibrium requires postural adjustments, some of which can be anticipatory. It is usually suggested that the role of anticipatory postural adjustments is to stabilise the whole body centre of mass. During movements performed at low velocity (i.e. with a lower inertial perturbation), anticipatory postural adjustments have not systematically been detected by classical recording methods (mainly electromyography). The aim of this study was to use vertical torque to characterise anticipatory postural adjustments in slow movement and to determine the significance of this biomechanical parameter. METHODS: Twenty healthy subjects performed self-paced, right arm-raising movements at low and high velocities. Movements were recorded by an optoelectronic system enabling the synchronization of video, force plate and electromyographic data. The force platform provided information on vertical torque and centre of foot pressure anteroposterior displacement. Electromyography activity was recorded from the right anterior deltoid and the bilateral biceps femoris, tibialis anterior and soleus muscles. FINDINGS: Rapid, voluntary, unilateral movements were associated with an early centre of pressure backward shift, anticipatory vertical torque and electromyographic activities. In slow movements, only the anticipatory changes in vertical torque were consistently observed, with the same latency as in rapid movement. INTERPRETATION: The existence of vertical torque in slow movement (when stabilisation of the centre of mass is not necessary) shows that this parameter does not serve to minimise the centre of mass displacement but rather contributes to the generation of arm movement.

Effects of subthalamic nucleus stimulation and levodopa treatment on gait abnormalities in Parkinson disease.

BACKGROUND: Stimulation of the subthalamic nucleus is proposed for the treatment of patients presenting with severe Parkinson disease. The effect on gait is not clearly established. OBJECTIVES: To evaluate objectively the influence of bilateral subthalamic nucleus stimulation on gait in Parkinson disease and to compare it with the effects of levodopa treatment. METHODS: Ten patients underwent bilateral subthalamic nucleus stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances, as well as spatial and temporal gait parameters, were analyzed in off and on-drug conditions. The gait analysis was performed using a video motion analysis system (optoelectronic VICON system; Oxford Metrics, Oxford, England). RESULTS: In the off condition, there was an improvement after surgery for the total motor score and the gait subscore. In the on-drug condition, there was an improvement in levodopa-induced dyskinesias and the motor score, whereas the gait subscore was unchanged. For the gait parameters measured by the video motion analysis system system, there was also an improvement in the off condition and to a lesser extent in the on-drug condition. CONCLUSIONS: Our method allowed exact quantification of the benefit of surgery on gait parameters. Compared with the levodopa treatment, the effect of stimulation on gait kinematic parameters seems to be qualitatively similar but quantitatively different with a lower benefit on gait velocity and stride length. Concerning the pathophysiology of gait troubles in Parkinson disease, the deficit in control of stride length would be the fundamental deficit. The study underlines the possible role of the subthalamic nucleus on the stride length regulation.

Basic mechanisms of central rhythms reactivity to preparation and execution of a voluntary movement: a stereoelectroencephalographic study.

OBJECTIVE: To localize the sources of mu, beta and gamma rhythms and to explore the functional significance of their reactivity. METHODS: We used the method of quantification of event-related desynchronization (ERD) and synchronization (ERS) to analyze the reactivity of intracerebral rhythms recorded in stereoelectroencephalography within the sensorimotor areas during the preparation and the execution of a simple self-paced hand movement. We recorded 3 epileptic subjects who were explored before a surgical treatment. RESULTS: An ERD of mu and beta rhythms has been recorded before the movement onset in the precentral gyrus, spreading then to the postcentral gyrus and to the frontal medial cortex. The frontal lateral cortex was inconstantly involved during the movement. The movement offset was followed by an important and focused beta ERS which was found within the pre- and post-central gyrus and the frontal medial cortex. Within the beta band, we observed several narrower bands with different reactivities and locations. Focused gamma reactivity was also found in the precentral and postcentral gyri. CONCLUSIONS: The reactivities of mu and beta rhythms are different but their locations overlap. Mu ERD is a diffuse phenomenon that reflects the activation of all the sensorimotor areas during a simple movement. Beta band is likely to be composed of different rhythms with different functional significance. The primary motor area seems to contain two distinct areas with different reactivity to the movement preparation and execution.

[Anticipatory postural adjustments associated with arm flexion: interest of vertical torque]. / Ajustements posturaux anticipés lors de la flexion du membre supérieur: intérêt du moment de torsion.

OBJECTIVE: To find a biomechanical parameter able to characterize postural adjustments in different movement conditions. METHODS: The arm-raising movement performed during the upright human position imposes a vertical torque (Tz) that can be measured by a force plate-form. This torque was studied in ten healthy young subjects with opto electronic system Vicon 370. The subjects stood on a force platform, performed shoulder flexion of their right arm, to grasp a handle in front of them, in five conditions : self-paced at 3 different velocities (slow, medium, maximal), triggered by an auditory signal, loaded (1 kg attached to the wrist), all at maximal velocity. In a sixth condition, the arm was passively displaced by an experimenter. RESULTS: Tz displayed a negative phase (counter-clock wise body rotation) in all conditions. A positive phase occurred prior to the negative one, and preceded movement onset only if the movement was voluntary. In the triggered condition, the positive phase of Tz was delayed (- 60 ms) compared to the self-paced condition at maximal velocity (- 155 ms). However Tz onset latency was modified neither by load nor velocity. Tz amplitude increased with increasing velocity, load and in a reaction time condition. CONCLUSIONS: The vertical torque Tz, especially its positive phase gives useful informations about the latency, duration and intensity of the postural preparation related to a voluntary movement, according to the movement parameters. Tz is therefore able to characterise postural adjustments in all conditions, even with low movement velocity.

Ankle dorsiflexion delay can predict falls in the elderly.

The aim of this study was to investigate the kinematic and kinetic characteristics of walking in healthy non-faller elderly in order to develop predictive parameters for falls. A 1-year prospective trial was completed on a walking circuit with two integrated force platforms and an optoelectronic system for three-dimensional movement analysis. Gait was investigated in 54 volunteers who were healthy people over 60 who had not fallen in the previous year. The subjects were contacted 2-monthly over a period of 1 year. The results showed that 16 of the 54 people tested had fallen. There was no significant age difference between the group of fallers and the group of non-fallers. Fallers walked more slowly and tended to use a double support for a longer period of time. Fallers were less powerful but mainly showed fewer power and moment variations. The range of motion at the ankle and the hip was reduced. We noticed a change in the walking pattern, showing a delay in the dorsiflexion of the ankle at the swing phase. In conclusion, subclinical gait parameters occur in older people. The advent of neuromotor pattern alterations when walking is related to the tendency to fall. Ankle dorsiflexion delays, in particular, appear to be predictive of falls.

Influence of pallidal stimulation and levodopa on gait and preparatory postural adjustments in Parkinson's disease.

In order to assess the influence of the bilateral internal globus pallidus (GPi) stimulation on gait and postural instability in Parkinson's disease (PD), we compared gait kinematic parameters and preparatory postural adjustments before and 3 months after stimulation in off- and on-drug conditions for seven patients. Gait kinematic parameters and displacements of centre of pressure (CP) and shoulder computed before a lateral raising task of the leg, were recorded using optoelectric Vicon system. Levodopa (L-dopa) induced a clear benefit for gait velocity (related to an increase of stride length) and also an increase of swing phase duration. GPi stimulation had a limited effect, since the increase of gait velocity was induced by a concomitant increase of stride length and cadence corresponding to a compensatory mechanism. The benefit on swing phase duration was also moderate. Displacements of CP were improved mainly by L-dopa. GPi stimulation and L-dopa had the same beneficial effect on the speed at which the CP was transferred back towards the support side, the ankle velocity, the onset time for ankle displacement, and the decrease of shoulder amplitude towards the support side, which reflects a better postural adjustment phase. This study, based on an objective method, revealed that chronic bilateral GPi stimulation may improve gait and preparatory postural adjustments in severe PD patients with a more limited effect than L-dopa.