Posture biofeedback increases cognitive load.

Attention may be important for actively maintaining posture during computer tasks, resulting in a dual-task tradeoff, where maintaining posture through extrinsic feedback imposes cognitive load. Mindfulness may make intrinsic postural feedback (which imposes less cognitive load) more available. Therefore, we hypothesized that the use of biofeedback would improve posture and negatively impact game performance; additionally, higher levels of mindfulness would be associated with lower game performance costs in the biofeedback condition. Healthy young adult participants played a challenging computer game for 10 min with and without neck length biofeedback, in a counterbalanced repeated-measures design. For each condition, we assessed posture using neck shrinkage (percentage of best), and task performance (computer game score). Neck length was better retained and game performance was worse with biofeedback than without, consistent with the hypothesis that posture biofeedback imposed a cognitive load. In addition, participants with the most neck shrinkage suffered the greatest performance decrements from using biofeedback, and neck length retention during the task without biofeedback was associated with lower self-reported daily neck pain and higher self-reported mindfulness. Thus, those with the greatest need for postural feedback suffer the greatest performance decrements from extrinsic feedback. The results are consistent with the idea that mindfulness enables people to use intrinsic feedback to maintain posture without imposing a dual-task cost.

Dual-task interference and brain structural connectivity in people with Parkinson's disease who freeze.

BACKGROUND: Freezing of gait in people with Parkinson's disease (PD) is likely related to attentional control (ie, ability to divide and switch attention). However, the neural pathophysiology of altered attentional control in individuals with PD who freeze is unknown. Structural connectivity of the pedunculopontine nucleus has been related to freezing and may play a role in altered attentional control; however, this relationship has not been investigated. We measured whether dual-task interference, defined as the reduction in gait performance during dual-task walking, is more pronounced in individuals with PD who freeze, and whether dual-task interference is associated with structural connectivity and/or executive function in this population. METHODS: We measured stride length in 13 people with PD with and 12 without freezing of gait during normal and dual-task walking. We also assessed asymmetry of pedunculopontine nucleus structural connectivity via diffusion tensor imaging and performance on cognitive tests assessing inhibition and set-shifting, cognitive domains related to freezing. RESULTS: Although stride length was not different across groups, change in stride length between normal and dual-task gait (ie, dual-task interference) was more pronounced in people with PD who freeze compared to non-freezers. Further, in people with PD who freeze, dual-task interference was correlated with asymmetry of pedunculopontine nucleus structural connectivity, Go-NoGo target accuracy (ability to release a response) and simple reaction time. CONCLUSIONS: These results support the hypothesis that freezing is related to altered attentional control during gait, and suggest that differences in pedunculopontine nucleus connectivity contribute to poorer attentional control in people with PD who freeze.

Asymmetric pedunculopontine network connectivity in parkinsonian patients with freezing of gait.

Freezing of gait is one of the most debilitating symptoms in Parkinson's disease as it causes falls and reduces mobility and quality of life. The pedunculopontine nucleus is one of the major nuclei of the mesencephalic locomotor region and has neurons related to anticipatory postural adjustments preceding step initiation as well as to the step itself, thus it may be critical for coupling posture and gait to avoid freezing. Because freezing of gait and postural impairments have been related to frontal lesions and frontal dysfunction such as executive function, we hypothesized that freezing is associated with disrupted connectivity between midbrain locomotor regions and medial frontal cortex. We used diffusion tensor imaging to quantify structural connectivity of the pedunculopontine nucleus in patients with Parkinson's disease with freezing of gait, without freezing, and healthy age-matched controls. We also included behavioural tasks to gauge severity of freezing of gait, quantify gait metrics, and assess executive cognitive functions to determine whether between-group differences in executive dysfunction were related to pedunculopontine nucleus structural network connectivity. Using seed regions from the pedunculopontine nucleus, we were able to delineate white matter connections between the spinal cord, cerebellum, pedunculopontine nucleus, subcortical and frontal/prefrontal cortical regions. The current study is the first to demonstrate differences in structural connectivity of the identified locomotor pathway in patients with freezing of gait. We report reduced connectivity of the pedunculopontine nucleus with the cerebellum, thalamus and multiple regions of the frontal cortex. Moreover, these structural differences were observed solely in the right hemisphere of patients with freezing of gait. Finally, we show that the more left hemisphere-lateralized the pedunculopontine nucleus tract volume, the poorer the performance on cognitive tasks requiring the initiation of appropriate actions and/or the inhibition of inappropriate actions, specifically within patients with freezing. These results support the notion that freezing of gait is strongly related to structural deficits in the right hemisphere's locomotor network involving prefrontal cortical areas involved in executive inhibition function.

Postural instructions affect postural sway in young adults.

BACKGROUND: Instructions to exert effort to correct one's posture are ubiquitous, but previous work indicates that effort-based postural instructions can impair balance control in older adults with and without neurodegenerative disease. Although less-studied, young adults are at high risk of injurious falls. RESEARCH QUESTION: How do different postural instructions influence static balance in young adults? METHODS: Single-session, counterbalanced, within-subjects design. Twenty young adults briefly practiced three different ways of thinking about their posture, then attempted to employ each way of thinking while standing on springy foam for 30 s with eyes open. Relax instructions were used as a baseline between experimental conditions. Effort-based instructions emulated popular concepts of posture correction using muscular exertion. Light instructions aimed at encouraging length and width while reducing excess tension. Postural sway was assessed with an inertial sensor at the low back. RESULTS: Effort-based postural instructions increased path length and jerk of postural sway during quiet stance, relative to Light and Relaxed instructions. SIGNIFICANCE: These results are consistent with previous work in older adults indicating that thinking of upright posture as inherently effortful impairs balance. Therefore, the common practice of instructing young adults to use effortful posture may impair their balance performance.

Altered coordination strategies during upright stance and gait in teachers of the Alexander Technique.

Deterioration in movement and posture often occurs with aging. Yet there may be approaches to movement training that can maintain posture and movement coordination patterns as we age. The Alexander Technique is a non-exercise-based approach that aims to improve everyday movement and posture by increasing awareness and modulating whole-body postural muscle activity. This study assessed whether nineteen 55-72-year-old Alexander Technique teachers showed different posture and movement coordination patterns than twenty age-matched controls during a standing and walking protocol using 3D inertial sensors. During upright stance, Alexander Technique teachers showed lower centroidal sway frequency at the ankle (p = .04) and lower normalized jerk at the sternum (p = .05) than controls. During gait, Alexander Technique teachers had more symmetrical gait cycles (p = .04), more symmetrical arm swing velocity (p = .01), greater arm swing velocity (p < .01), greater arm swing range of motion (p = .02), and lower range of acceleration of the torso in the frontal plane (p = .03) than controls. Smoother control of upright posture, more stable torso motion, and less restrained arm mobility suggest that Alexander Technique training may counter movement degradation that is found with aging. Results highlight the important balance between mobility and stability within the torso and limbs.

Effect of sit-stand workstation position and computer task on head and trunk postural sway and discomfort.

Adjustable-height desks may provide musculoskeletal health benefits to offset the effects of prolonged sitting. One mechanism may be increased postural variability, here characterized by head and trunk postural sway. Linear acceleration of the head and trunk were measured while participants used computer workstations in seated and standing positions during keyboard and mouse tasks; secondary measures were discomfort and proprioception (head and neck repositioning error). Median accelerations of the head and trunk were 20-26% lower in mouse tasks compared to keyboard tasks (p < 0.01). There were no significant differences in sway parameters between seated and standing positions. Discomfort and proprioception were correlated; subjects who experienced increased neck discomfort after 1.5 h of computer work had almost twice the head and neck repositioning error. The results suggest that postural sway is more affected by different tasks (keyboard vs. mouse) than by different workstation configurations and that low proprioception acuity may relate to the development of discomfort.

State space analysis of timing: exploiting task redundancy to reduce sensitivity to timing.

Timing is central to many coordinated actions, and the temporal accuracy of central nervous system commands presents an important limit to skilled performance. Using target-oriented throwing in a virtual environment as an example task, this study presents a novel analysis that quantifies contributions of timing accuracy and shaping of hand trajectories to performance. Task analysis reveals that the result of a throw is fully determined by the projectile position and velocity at release; zero error can be achieved by a manifold of position and velocity combinations (solution manifold). Four predictions were tested. 1) Performers learn to release the projectile closer to the optimal moment for a given arm trajectory, achieving timing accuracy levels similar to those reported in other timing tasks (~10 ms). 2) Performers develop a hand trajectory that follows the solution manifold such that zero error can be achieved without perfect timing. 3) Skilled performers exploit both routes to improvement more than unskilled performers. 4) Long-term improvement in skilled performance relies on continued optimization of the arm trajectory as timing limits are reached. Average and skilled subjects practiced for 6 and 15 days, respectively. In 6 days, both timing and trajectory alignment improved for all subjects, and skilled subjects showed an advantage in timing. With extended practice, performance continued to improve due to continued shaping of the trajectory, whereas timing accuracy reached an asymptote at 9 ms. We conclude that skilled subjects first maximize timing accuracy and then optimize trajectory shaping to compensate for intrinsic limitations of timing accuracy.

The interaction of postural and voluntary strategies for stability in Parkinson's disease.

This study assessed the effects of stability constraints of a voluntary task on postural responses to an external perturbation in subjects with Parkinson's disease (PD) and healthy elderly participants. Eleven PD subjects and twelve control subjects were perturbed with backward surface translations while standing and performing two versions of a voluntary task: holding a tray with a cylinder placed with the flat side down [low constraint (LC)] or with the rolling, round side down [high constraint (HC)]. Participants performed alternating blocks of LC and HC trials. PD participants accomplished the voluntary task as well as control subjects, showing slower tray velocity in the HC condition compared with the LC condition. However, the latency of postural responses was longer in the HC condition only for control subjects. Control subjects presented different patterns of hip-shoulder coordination as a function of task constraint, whereas PD subjects had a relatively invariant pattern. Initiating the experiment with the HC task led to 1) decreased postural stability in PD subjects only and 2) reduced peak hip flexion in control subjects only. These results suggest that PD impairs the capacity to adapt postural responses to constraints imposed by a voluntary task.

Keeping your balance while balancing a cylinder: interaction between postural and voluntary goals.

The present study investigated whether postural responses are influenced by the stability constraint of a voluntary, manual task. We also examined how task constraint and first experience (the condition with which the participants started the experiment) influence the kinematic strategies used to simultaneously accomplish a postural response and a voluntary task. Twelve healthy, older adults were perturbed during standing, while holding a tray with a cylinder placed with the flat side down (low constraint, LC) or with the rolling, round side down (high constraint, HC). Central set changed according to the task constraint, as shown by a higher magnitude of both the gastrocnemius and tibialis anterior muscle activation bursts in the HC than in the LC condition. This increase in muscle activation was not reflected, however, in changes in the center of pressure or center of mass displacement. Task constraint influenced the peak shoulder flexion for the voluntary tray task but not the peak hip flexion for the postural task. In contrast, first experience influenced the peak hip flexion but not the peak shoulder flexion. These results suggest an interaction between two separate control mechanisms for automatic postural responses and voluntary stabilization tasks.

Prospective and retrospective effects in human motor control: planning grasps for object rotation and translation.

People pick up objects in ways that reflect prospective as well as retrospective control. Prospective control is indicated by planning for end-state comfort such that people grasp a cylinder to be rotated or translated with a hand orientation or at a height that affords a comfortable final posture. Retrospective control is indicated when people reuse a remembered grasp rather than using a new grasp that would ensure end-state comfort. Here, we asked whether these manifestations of prospective and retrospective control co-occur. We did so by having healthy young-adult participants grasp a cylinder to rotate and translate it between a horizontal position and a vertical position at each of five heights. We found that participants planned for comfortable final hand orientations for first moves but relied on recall for subsequent hand orientations. The results suggest that motor planning is sensitive to computational as well as physical demands and that object rotation and translation are not dissociable features of motor control, at least as reflected in their contributions to grasp selection. The latter result is consistent with the hypothesis that movements constitute holistic body changes between successive goal postures.

Manual obstacle avoidance takes into account visual uncertainty, motor noise, and biomechanical costs.

Moving around obstacles requires balancing the need to avoid collisions with the need to minimize biomechanical costs. We investigated this tradeoff by studying the effects of visual uncertainty, motor noise, and practice on clearance over obstacles in a manual positioning task. Participants moved a manipulandum back and forth over a stationary obstacle. We varied visual uncertainty by placing the obstacle at different heights relative to participants' eyes, and we varied motor noise by having participants hold the object to be moved at different positions relative to the range of motion of the arm joints. Clearance was larger in conditions of higher visual uncertainty than in conditions of lower visual uncertainty, larger in the higher motor noise conditions than in the lower motor noise conditions, and larger early in practice than late in practice. The results indicate that spatial accuracy and biomechanical costs are both taken into account during reaching over obstacles, but to differing degrees across practice.

Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

BACKGROUND AND OBJECTIVES: Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson's disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults. RESEARCH DESIGN AND METHODS: Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. "Light" instructions relied on principles of reducing excess tension while encouraging length. "Effortful" instructions relied on popular concepts of effortful posture correction. "Relax" instructions encouraged minimization of effort. We measured kinematics and muscle activity. RESULTS: During quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles. DISCUSSION AND IMPLICATIONS: Thinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.

Brain networks associated with anticipatory postural adjustments in Parkinson's disease patients with freezing of gait.

Specific impairments of anticipatory postural adjustment (APA) during step initiation have been reported in patients with Parkinson's disease (PD) and freezing of gait (FoG). Although APA disruption has been associated with FoG, there is scarce knowledge about its neural correlates. We sought to better understand the neural networks involved with APA in patients with FoG by assessing the level of hemodynamic response of specific brain regions and the functional connectivity during the leg lifting task. In the current investigation, APAs of patients with PD, with and without (nFoG) freezing were assessed during a leg lifting task in an event-related, functional magnetic resonance imaging (er-fMRI) protocol. Results identified a high hemodynamic response in the right anterior insula (AI) and supplementary motor area (SMA) in the FoG group when an APA was required. The nFoG had stronger connectivity between the right and left insulae than the FoG group. The strength of this connectivity was negatively correlated with the severity of FoG. Both groups showed different brain network organizations comprising the SMA and the bilateral AI. The SMA was found to be a hub in patients with FoG when an APA was required for the task. Our findings suggest that both groups used compensatory mechanism comprising the insulae during APA. Neither group used the entire network comprised of the insulae and SMA to accomplish the task. The FoG group relied more on SMA as a hub than as part of a broader network to exchange information during the APA.

The posture-based motion planning framework: new findings related to object manipulation, moving around obstacles, moving in three spatial dimensions, and haptic tracking.

We describe the results of recent studies inspired by the posture-based motion planning theory (Rosenbaum et al., 2001). The research concerns analyses of human object manipulation, obstacle avoidance, three-dimensional movement generation, and haptic tracking, the findings of which are discussed in relation to whether they support or fail to support the premises of the theory. Each of the aforementioned topics potentially challenges the theory's claim that, in motion, goal postures are planned before the selection of movements towards those postures. However, even the quasi-continuous phenomena under study show features that comply with prospective, end-state-based motion planning. We conclude that progress in motor control should not be frustrated by the view that no model is, or will ever be, optimal. Instead, it should find promise in the steady growth of insights afforded by challenges to existing theories.

Neck posture is influenced by anticipation of stepping.

BACKGROUND: Postural deviations such as forward head posture (FHP) are associated with adverse health effects. The causes of these deviations are poorly understood. We hypothesized that anticipating target-directed movement could cause the head to get "ahead of" the body, interfering with optimal head/neck posture, and that the effect may be exacerbated by task difficulty and/or poor inhibitory control. METHOD: We assessed posture in 45 healthy young adults standing quietly and when they anticipated walking to place a tray: in a simple condition and in conditions requiring that they bend low or balance an object on the tray. We defined FHP as neck angle relative to torso; we also measured head angle relative to neck and total neck length. We assessed inhibitory control using a Go/No-Go task, Stroop task, and Mindful Attention Awareness Scale (MAAS). RESULTS: FHP increased when participants anticipated movement, particularly for more difficult movements. Worse Stroop performance and lower MAAS scores correlated with higher FHP. False alarms on the Go/No-Go task correlated with a more extended head relative to the neck and with shortening of the neck when anticipating movement. CONCLUSIONS: Maintaining neutral posture may require inhibition of an impulse to put the head forward of the body when anticipating target-directed movement.

Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain.

OBJECTIVES: To determine feasibility and potential of Alexander technique (AT) group classes for chronic neck pain and to assess changes in self-efficacy, posture, and neck muscle activity as potential mechanisms for pain reduction. DESIGN: A single-group, multiple-baseline design, with two pre-tests to control for regression toward the mean, a post-test immediately after the intervention, and another post-test five weeks later to examine retention of benefits. Participants were predominately middle-aged; all had experienced neck pain for at least six months. INTERVENTION: Participants attended ten one-hour group classes in AT, an embodied mindful approach that may reduce habitual overactivation of muscles, including superficial neck muscles, over five weeks. OUTCOME MEASURES: (1) self-reports: Northwick Park Questionnaire (to assess neck pain and associated disability) and Pain Self-Efficacy Questionnaire; (2) superficial neck flexor activation and fatigue (assessed by electromyography and power spectral analysis) during the cranio-cervical flexion test; (3) posture during a video game task. RESULTS: There were no significant changes in outcomes between pre-tests. All participants completed the intervention. After the intervention: (1) participants reported significantly reduced neck pain; (2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; (3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another. CONCLUSIONS: Group AT classes may provide a cost-effective approach to reducing neck pain by teaching participants to decrease excessive habitual muscle contraction during everyday activity.

The problem of serial order in behavior: Lashley's legacy.

In a prescient paper Karl Lashley (1951) rejected reflex chaining accounts of the sequencing of behavior and argued instead for a more cognitive account in which behavioral sequences are typically controlled with central plans. An important feature of such plans, according to Lashley, is that they are hierarchical. Lashley offered several sources of evidence for the hierarchical organization for behavioral plans, and others afterward provided more evidence for this hypothesis. We briefly review that evidence here and then shift from a focus on the structure of plans (Lashley's point of concentration) to the processes by which plans are formed in real time. Two principles emerge from the studies we review. One is that plans are not formed from scratch for each successive movement sequence but instead are formed by making whatever changes are needed to distinguish the movement sequence to be performed next from the movement sequence that has just been performed. This plan-modification view is supported by two phenomena discovered in our laboratory: the parameter remapping effect, and the handpath priming effect. The other principle we review is that even single movements appear to be controlled with hierarchically organized plans. At the top level are the starting and goal postures. At the lower level are the intermediate states comprising the transition from the starting posture to the goal posture. The latter principle is supported by another phenomenon discovered in our lab, the end-state comfort effect, and by a computational model of motor planning which accounts for a large number of motor phenomena. Interestingly, the computational model hearkens back to a classical method of generating cartoon animations that relies on the production of keyframes first and the production of interframes (intermediate frames) second.

Recovery from Multiple APAs Delays Gait Initiation in Parkinson's Disease.

Background: Freezing of gait in Parkinson's disease (PD) has been linked with deficits in inhibitory control, but causal mechanisms are not established. Freezing at gait initiation (start hesitation) is often accompanied by multiple anticipatory postural adjustments (APAs). If inhibition deficits contribute to freezing by interfering with ability to inhibit initial weight shifts in the wrong direction, then PD subjects should experience more episodes of multiple APAs than healthy controls (HCs) do. If inhibition deficits contribute to freezing by interfering with ability to release a previously inhibited step following multiple APAs, then step onset following multiple APAs should be delayed more in people with PD than in HCs. Methods: Older adults with PD and HC subjects rapidly initiated stepping in response to a light cue in blocks of simple (SRT) and choice (CRT) conditions. We recorded kinematics and ground reaction forces, and we administered the Stroop task to assess inhibitory control. Results: Multiple APAs were more common in CRT than SRT conditions but were equally common in HC and PD subjects. Step onsets were delayed in both conditions and further delayed in trials with multiple APAs, except for HC subjects in SRT trials. Poor Stroop performance correlated with many multiple APAs, late step onset, and rearward position of center of mass (COM) at cue presentation. Forward motion of the COM during the APA was higher in trials with multiple APAs than in trials with single APAs, especially in CRT trials and in PD subjects without self-reported freezing. Conclusion: Start hesitation is not caused by multiple APAs per se, but may be associated with difficulty recovering from multiple APAs, due to difficulty releasing a previously inhibited step.

The clinical significance of freezing while turning in Parkinson's disease.

Freezing of gait (FoG) in people with Parkinson's disease (PD) is an environmentally sensitive, intermittent problem that occurs most often during turning. FoG is difficult for clinicians to evaluate and treat because it can be difficult to elicit during a clinical visit. Here, we aimed to develop a clinically valid objective measure of freezing severity during a 2-min 360-degree turning-in-place. Twenty-eight subjects with PD (16 freezers, FoG+, and 12 nonfreezers, FoG-) in the "off" state and 14 healthy control subjects were tested. Subjects wore three inertial sensors (one on each shin and one on the waist) while (1) turning in place for 2 min (alternating 360 degrees to the right with 360 degrees to the left) and (2) performing an Instrumented 7-m Timed Up and Go test (ITUG). Performance was videotaped, and clinical severity of FoG was independently rated by two movement disorders specialists (co-authors). Turning in place consistently resulted in FoG (13 out of 16 subjects with PD) while FoG was clinically observed in only two subjects with PD during the ITUG test. The Freezing Ratio during the turning test was significantly correlated with the clinical ratings (ρ=0.7, p=0.003) and with score on the new FoG questionnaire (ρ=0.5, p=0.03). After correcting for symptom severity (UPDRS-III), out of the four objective measures of the turning test (total number of turns, average turn peak speed and average turn smoothness), only the Freezing Ratio was significantly different across groups (p=0.04). Freezing can be well quantified with body-worn inertial sensors during a 2-min turning-in-place protocol.