Stepping boundary of external force-controlled perturbations of varying durations: Comparison of experimental data and model simulations.

This study investigated the stepping boundary - the force that can be resisted without stepping - for force-controlled perturbations of different durations. Twenty-two healthy young adults (19-37 years old) were instructed to try not to step in response to 86 different force/time combinations of forward waist-pulls. The forces at which 50% of subjects stepped (F50) were identified for each tested perturbation durations. Results showed that F50 decreased hyperbolically when the perturbation's duration increased and converged toward a constant value (about 10%BW) for longer perturbations (over 1500 ms). The effect of perturbation duration was critical for the shortest perturbations (less than 1 s). In parallel, a simple function was proposed to estimate this stepping boundary. Considering the dynamics of a linear inverted pendulum + foot model and simple balance recovery reactions, we could express the maximum pulling force that can be withstood without stepping as a simple function of the perturbation duration. When used with values of the main model parameters determined experimentally, this function replicated adequately the experimental results. This study demonstrates for the first time that perturbation duration has a major influence on the outcomes of compliant perturbations such as force-controlled pulls. The stepping boundary corresponds to a constant perturbation force-duration product and is largely explained by only two parameters: the reaction time and the displacement of the center of pressure within the functional base of support. Future work should investigate pathological populations and additional parameters characterizing the perturbation time-profile such as the time derivative of the perturbation.

Kinematic features of whole-body reaching movements underwater: Neutral buoyancy effects.

Astronauts' training is conventionally performed in a pool to reproduce weightlessness by exploiting buoyancy which is supposed to reduce the impact of gravity on the body. However, this training method has not been scientifically validated yet, and requires first to study the effects of underwater exposure on motor behavior. We examined the influence of neutral buoyancy on kinematic features of whole-body reaching underwater and compared them with those produced on land. Eight professional divers were asked to perform arm reaching movements toward visual targets while standing. Targets were presented either close or far from the subjects (requiring in the latter case an additional whole-body displacement). Reaching movements were performed on land or underwater in two different contexts of buoyancy. The divers either wore a diving suit only with neutral buoyancy applied to their center of mass or were additionally equipped with a submersible simulated space suit with neutral buoyancy applied to their body limbs. Results showed that underwater exposure impacted basic movement features, especially movement speed which was reduced. However, movement kinematics also differed according to the way buoyancy was exerted on the whole-body. When neutral buoyancy was applied to the center of mass only, some focal and postural components of whole-body reaching remained close to land observations, notably when considering the relative deceleration duration of arm elevation and concomitant forward trunk bending when reaching the far target. On the contrary, when neutral buoyancy was exerted on body segments, movement kinematics were close to those reported in weightlessness, as reflected by the arm deceleration phase and the whole-body forward displacement when reaching the far target. These results suggest that astronauts could benefit from the application of neutral buoyancy across the whole-body segments to optimize underwater training and acquire specific motor skills which will be used in space.

To pass or not to pass: more a question of body orientation than visual cues.

This study investigated the influence of pitch body tilt on judging the possibility of passing under high obstacles in the presence of an illusory horizontal self-motion. Seated subjects tilted at various body orientations were asked to estimate the possibility of passing under a projected bar (i.e., a parking barrier), while imagining a forward whole-body displacement normal to gravity. This task was performed under two visual conditions, providing either no visual surroundings or a translational horizontal optic flow that stopped just before the barrier appeared. The results showed a main overestimation of the possibility of passing under the bar in both cases and most importantly revealed a strong influence of body orientation despite the visual specification of horizontal self-motion by optic flow (i.e., both visual conditions yielded a comparable body tilt effect). Specifically, the subjective passability was proportionally deviated towards the body tilt by 46% of its magnitude when facing a horizontal optic flow and 43% without visual surroundings. This suggests that the egocentric attraction exerted by body tilt when referring the subjective passability to horizontal self-motion still persists even when anchoring horizontally related visual cues are displayed. These findings are discussed in terms of interaction between spatial references. The link between the reliability of available sensory inputs and the weight attributed to each reference is also addressed.

Sympathetic reinnervation 1 year after heart transplantation, assessed using iodine-123 metaiodobenzylguanidine imaging.

Complete allograft denervation occurs during heart transplantation (HT). Partial ventricular sympathetic reinnervation that may develop after transplantation can be measured using iodine-123 meta iodobenzylguanidine (MIBG) uptake. Previous studies have suggested that reinnervation is likely to be a slow process, only occurring after 1 year posttransplantation. However, the reinnervation prevalence at 1 year after HT remains unknown. This study sought to determine sympathetic reinnervation measured by MIBG at 12 months after surgery. We performed serial cardiac MIBG imaging in 45 cardiac transplant recipients, including 32 males and 13 females, early (2 months) and late (12 months) after the operation. The intensity of myocardial MIBG uptaken was quantified by heart-to-mediastinum ratios (HMR). Reinnervation was considered when the HMR was >1.3. HMR was significantly higher at 12 months: 1.16 ± 0.10 at 2 vs 1.30 ± 0.15 at 12 months (P < .001). Eighteen (40%) of 45 subjects developed visible cardiac MIBG uptake at 1 year after transplantation with HMR >1.3. In conclusion, partial sympathetic reinnervation increases with time after HT; it was seen in 40% of patients at 1 year after the operation.

Postural configuration affects the perception of earth-based space during pitch tilt.

This study investigates the relative contribution of body parts in the elaboration of a whole-body egocentric attraction phenomenon previously observed during earth-based judgments. This was addressed through a particular earth-based task requiring estimating the possibility of passing under a projected line, imagining a forward horizontal displacement. Different postural configurations were tested, involving whole-body tilt, trunk tilt alone or head tilt alone. Two legs positions relative to the trunk were manipulated. Results showed systematic deviations of the subjective "passability" toward the tilt, linearly related to the tilt magnitude. For each postural configuration, the egocentric influence appeared to be highly dependent on the position of trunk and head axes, whereas the legs position appeared not relevant. When compared to the whole-body tilt condition, tilting the trunk alone consistently reduced the amount of the deviation toward the tilt, whereas tilting the head alone consistently increased it. Our results suggest that several specific effects from multiple body parts can account for the global deviation of the estimates observed during whole-body tilt. Most importantly, we support that the relative contribution of the body segments could mainly depend on a reweighting process, probably based on the reliability of sensory information available for a particular postural set.

Pitch body orientation influences the perception of self-motion direction induced by optic flow.

We studied the effect of static pitch body tilts on the perception of self-motion direction induced by a visual stimulus. Subjects were seated in front of a screen on which was projected a 3D cluster of moving dots visually simulating a forward motion of the observer with upward or downward directional biases (relative to a true earth horizontal direction). The subjects were tilted at various angles relative to gravity and were asked to estimate the direction of the perceived motion (nose-up, as during take-off or nose-down, as during landing). The data showed that body orientation proportionally affected the amount of error in the reported perceived direction (by 40% of body tilt magnitude in a range of +/-20 degrees) and these errors were systematically recorded in the direction of body tilt. As a consequence, a same visual stimulus was differently interpreted depending on body orientation. While the subjects were required to perform the task in a geocentric reference frame (i.e., relative to a gravity-related direction), they were obviously influenced by egocentric references. These results suggest that the perception of self-motion is not elaborated within an exclusive reference frame (either egocentric or geocentric) but rather results from the combined influence of both.

[Somatostatin receptor scintigraphy in pediatric bronchial carcinoid tumor]. / Gammagrafía con análogos de la somatostatina en el diagnóstico y el seguimiento del carcinoide bronquial pediátrico.

INTRODUCTION: Carcinoid tumor is a rare neuroendocrine neoplasm with different locations, the most frequent ones during the pediatric age being the appendix and lung. Scintigraphy with (111)In-DTPA-d-Phe(1)-octreotide has led to an importance advance in the diagnosis of extension in carcinoid tumor patients. We present three pediatric patients with bronchial carcinoid studied with somatostatin analogue scintigraphy (SSRS). CLINICAL CASES: The first patient (9 years) was studied using the SSRS after surgery due to carcinoid tumor in the right lower lobe in which tumor remains was observed (this being clearer in the tomography study). The second patient (10 years) presented due to endobronchial tumor in the left lower lobe together with atelectasis of the LUL and emphysema of the LLL. Radiology imaging techniques suggested the differential diagnosis between the endobronchial carcinoid tumor or plasma cells or foreign body gramuloma. The SSRS showed an abnormal deposit of activity in the left hemithorax consisted with carcinoid tumor. No other areas suggesting metastasis were observed. After the surgery (endobronchial resection), new controls with SSRS showed absence of disease. The third patient (12 years) came after a lobectomy (RUL) due to bronchial carcinoid. The SSRS did not show any abnormal areas of activity. In the subsequent control (3 months), a deposit of activity was observed in the middle third of the right hemithorax, after which a lobectomy was performed (RLL and ML) that showed small remains of neuroendocrine carcinoid. Subsequent controls were negative. CONCLUSION: The SSRS has demonstrated great utility in the diagnosis, follow-up and staging of pediatric patients, carriers of neuroendocrine carcinoid tumors.

Judging beforehand the possibility of passing under obstacles without motion: the influence of egocentric and geocentric frames of reference.

Previous studies have shown that the perception of the earth-based visual horizon, also named Gravity Referenced Eye Level (GREL), is modified by body tilt around a trans-ocular axis. Here, we investigated whether estimates of the elevation of a luminous horizontal line presented on a screen in otherwise darkness and estimates of the possibility of passing under are identically related to body tilt in absence of motion. Results showed that subjects overestimated the elevation of the projected line, whatever their body orientation. In the same way, subjects also overestimated their capacity of passing under the line. Both estimates appeared as a linear function of body tilt, that is, forward body tilt yielded increased overestimations, and backward body tilt yielded decreased overestimations. More strikingly, the linear effect of body tilt upon these estimates is comparable to that previously observed for direct GREL judgements. Overall, these data strongly suggest that the perception of the elevation of a visible obstacle and the perception of the ability of passing under in otherwise darkness shared common processes which are intimately linked to the GREL perception. The effect of body tilt upon these perceptions may illustrate an egocentric influence upon the semi-geocentric frame of reference required to perform the task. Possible interactions between egocentric and geocentric frames of reference are discussed.

Vision of the hand prior to movement onset allows full motor adaptation to a multi-force environment.

In everyday life, because of unexpected mechanical perturbation applied to the hand or to the whole body, hand movements may become suddenly inaccurate. With prolonged exposure to the perturbation, trajectories slowly recover their normal accuracy, which is the mark of motor adaptation. However, full development of this adaptive process in complete darkness has been recently challenged in a multi-force environment. Here, we report on the effectiveness of static hand position information as specified through vision prior to movement onset on the adaptative changes, over trials, of pointing movements performed in a gravitoinertial force field. For this, subjects seated off-center on a platform rotating at constant velocity, were either confined to complete darkness (No Vision Session, NV) or provided with vision of the hand resting on the starting position prior to movement onset (Hand Vision Prior to Movement Session, HVPM). Overall, our results showed that adaptation to the centrifugal force was very rapid, and allowed subjects to demonstrate appropriate motor control as early as of the very first trials performed during the rotation period, even in the NV condition. They also showed that the integration by the Central Nervous System (CNS) of visual and proprioceptive information prior to the execution of a reaching movement allows subjects to reach full motor adaptation in a multi-force environment. Furthermore, our data confirm the existence of differentiated motor adaptive mechanisms for centrifugal and Coriolis forces. Adaptation to the former may fully develop on the basis of an a priori coding of the characteristics of the background force level even without visual information, while the latter needs visual cues about hand position prior to movement onset to take place.

Effects of head orientation and lateral body tilt on egocentric coding: cognitive and sensory-motor accuracy.

A major issue in motor control studies is to determine whether and how we use spatial frames of reference to organize our spatially oriented behaviors. In previous experiments we showed that simulated body tilt during off-axis rotation affected the performance in verbal localization and manual pointing tasks. It was hypothesized that the observed alterations were at least partly due to a change in the orientation of the egocentric frame of reference, which was indeed centered on the body but aligned with the gravitational vector. The present experiments were designed to test this hypothesis in a situation where no inertial constraints (except the usual gravitational one) exist and where the orientation of the body longitudinal z-axis was not aligned with the direction of the gravity. Eleven subjects were exposed to real static body tilt and were required to verbally localize (experiment 1) and to point as accurately as possible towards (experiment 2) memorized visual targets, in two conditions, Head-Free and Head-Fixed conditions. Results show that the performance was only affected by real body tilt in the localization task performed when the subject's head was tilted relative to the body. Thus, dissociation between gravity and body longitudinal z-axis alone is not responsible for localization nor for pointing errors. Therefore, the egocentric frame of reference seems independent from the orientation of the gravity with regard to body z-axis as expected from our previous studies. Moreover, the use of spatial referentials appears to be less mandatory than expected for pointing movements (motor task) than for localization task (cognitive task).

Accuracy of spatial localization depending on head posture in a perturbed gravitoinertial force field.

Spatial orientation is crucial when subjects have to accurately reach memorized visual targets. In previous studies modified gravitoinertial force fields were used to affect the accuracy of pointing movements in complete darkness without visual feedback of the moving limb. Target mislocalization was put forward as one hypothesis to explain this decrease in accuracy of pointing movements. The aim of this study was to test this hypothesis by determining the accuracy of spatial localization of memorized visual targets in a perturbed gravitoinertial force field. As head orientation is involved in localization tasks and carrying relevant sensory systems (visual, vestibular and neck muscle proprioceptive), we also tested the effect of head posture on the accuracy of localization. Subjects (n=10) were seated off-axis on a rotating platform (120 degrees s(-1)) in complete darkness with the head fixed (head-fixed session) or free to move (head-free session). They were required to report verbally the egocentric spatial localization of visual memorized targets. They gave the perceived target location in direction (i.e. left or right) and in amplitude (in centimeters) relative to the direction they thought to be straight ahead. Results showed that the accuracy of visual localization decreased when subjects were exposed to inertial forces. Moreover, subjects localized the memorized visual targets more to the right than their actual position, that was in the direction of the inertial forces. With further analysis, it appeared that this shift of localization was concomitant with a shift of the visual straight ahead (VSA) in the opposite direction. Thus, the modified gravitoinertial force field led to a modification in the orientation of the egocentric reference frame. Furthermore, this shift of localization increased when the head was free to move while the head was tilted in roll toward the center of rotation of the platform and turned in yaw in the same direction. It is concluded that the orientation of the egocentric reference frame was influenced by the gravitoinertial vector.

Galvanic vestibular stimulation in humans produces online arm movement deviations when reaching towards memorized visual targets.

Using galvanic vestibular stimulation (GVS), we tested whether a change in vestibular input at the onset of goal-directed arm movements induces deviations in arm trajectory. Eight head-fixed standing subjects were instructed to reach for memorized visual targets in complete darkness. In half of the trials, randomly-selected, a 3 mA bipolar binaural galvanic stimulation of randomly alternating polarity was triggered by the movement onset. Results revealed significant GVS-induced directional shifts of reaching movements towards the anode side. The earliest significant deviations of hand path occurred 240 ms after stimulation onset. The likely goal of these online deviations of arm trajectory was to compensate for a vestibular-evoked apparent change in the spatial relationship between the target and the hand.

Supramodal effects of galvanic vestibular stimulation on the subjective vertical.

This study investigated whether the tilt of the subjective vertical induced by galvanic vestibular stimulation, demonstrated by asking subjects to set a rod to the vertical, was specific to the visual modality or could be found in two tasks relying on proprioceptive and somatosensory cues. In all cases, settings were significantly deviated in the direction of the anode, but errors were smaller in the somatosensory tasks than in the visual task. We propose that the effects observed in the somatosensory modality reflects only a modification of the central representation of gravity, whereas visual effects are also in part the consequence of unregistered ocular torsion.

Visual feedback of the moving arm allows complete adaptation of pointing movements to centrifugal and Coriolis forces in human subjects.

A classical visuo-manual adaptation protocol carried out on a rotating platform was used to test the ability of subjects to adapt to centrifugal and Coriolis forces when visual feedback of the arm is manipulated. Three main results emerge: (a) an early modification of the initial trajectory of the movements takes place even without visual feedback of the arm; (b) despite the change in the initial trajectory, the new external force decreases the accuracy of the pointing movements when vision is precluded; (c) a visual adaptive phase allows complete adaptation of the pointing movements performed in a modified gravitoinertial field. Therefore vision would be essential for subjects to completely adapt to centrifugal and Coriolis forces. However, other sensory signals (i.e. vestibular and proprioceptive) may constitute the basis for early but partial correction of the pointing movements.

Surgical modification of the AC/A ratio and the binocular alignment ("Phoria") at distance; its influence on accommodative esotropia: a study of 21 cases.

PURPOSE: To study these changes in patients and their relation to manifestation of accommodative esotropia and response to surgery. METHODS: Patient-subjects: 21 patients who had difficulty adjusting to spectacle correction and underwent bilateral medial rectus loop suspension-recession surgery to alleviate their accommodative esotropia. Measurements of AC/A, uncorrected distance phoria, and related parameters were taken before and after surgical intervention was performed and were analyzed using analysis of variance (ANOVA). RESULTS: Both AC/A ratios and the distance phorias are "statistically significantly" (p< or =0.05), and independently, reduced by this surgical procedure. The manifestation of accommodative esotropia and response to surgery can be fairly accurately predicted from the values of AC/A ratio and distance phoria. CONCLUSION: Surgical treatment of accommodative esotropia creates well defined, long-lasting reductions in the AC/A ratio and the distance phoria.

The role of proprioception and attention in a visuomotor adaptation task.

The role of proprioception in the control and adaptation of visuomotor relationships is still unclear. We have studied a deafferented subject, IW, and control subjects in a task in which they used single joint elbow extension to move to a visual target, with visual feedback of the terminal position provided by a cursor displayed in the plane of their movements. We report the differences in movement accuracy between the deafferented subject and controls in the normal task and when challenged with a cognitive load, counting backwards. All subjects were less accurate when counting; this was a small effect for the controls (<10% change) but much greater for the deafferented subject (>60% change). We also examined changes in movement kinematics when the instructed amplitude was altered via a changed gain between final arm position and presentation of the feedback cursor. The deafferented subject maintained temporal movement parameters stable and altered amplitude by scaling force (i.e. changed peak velocity), whereas the controls scaled both movement velocity and duration. Finally, we compared the subjects' adaptation of movement amplitude after a period of exposure to the changed visuomotor gain. The deafferented subject was able to adapt, but his adaptation was severely impaired by the counting task. These results suggest that proprioception is not an absolute requirement for adaptation to occur. Instead, proprioception has a more subtle role to play in the adjustment to visuomotor perturbations. It has an important role in the control of reaching movements, while in the absence of proprioception, attention appears necessary to monitor movements.

Does the oculo-manual co-ordination control system use an internal model of the arm dynamics?

The hypothesis that during self-moved target tracking, the eye-arm co-ordination control system uses an internal model of the arm dynamics was tested. The contribution of arm proprioception to this model was also assessed. Subjects (nine healthy adults and one deafferented subject) were requested to make forearm movements and visually track an arm-driven target. Unexpected changes in mechanical properties of the manipulandum were used to modify the dynamical conditions of arm movement. The smooth pursuit gain (SPG) was computed before and during the perturbation. Results showed a decrease of SPG during perturbation in control subjects only. We propose that an internal model of the arm dynamics may be used to co-ordinate eye and arm movements, and arm proprioception may contribute to this internal model.

The oculomanual coordination control center takes into account the mechanical properties of the arm.

When the eyes and arm are involved in a tracking task, the characteristics of each system differ from those observed when they act alone: smooth pursuit (SP) latency decreases from 130 ms in external target tracking tasks to 0 ms in self-moved target tracking tasks. Two models have been proposed to explain this coordination. The common command model suggests that the same command be addressed to the two sensorimotor systems, which are otherwise organized in parallel, while the coordination control model proposes that coordination is due to a mutual exchange of information between the motor systems. In both cases, the interaction should take into account the dynamic differences between the two systems. However, the nature of the adaptation depends on the model. During self-moved target tracking a perturbation was applied to the arm through the use of an electromagnetic brake. A randomized perturbation of the arm increased the arm motor reaction time without affecting SP. In contrast, a constant perturbation produced an adaptation of the coordination control characterized by a decrease in arm latency and an increase in SP latency relative to motor command. This brought the arm-to-SP latency back to 0 ms. These results support the coordination control model.

Updating visual space during passive and voluntary head-in-space movements.

The accuracy of our spatially oriented behaviors largely depends on the precision of monitoring the change in body position with respect to space during self-motion. We investigated observers' capacity to determine, before and after head rotations about the yaw axis, the position of a memorized earth-fixed visual target positioned 21 degrees laterally. The subjects (n=6) showed small errors (mean=-0.6 degrees) and little variability (mean=0.9 degrees) in determining the position of an extinguished visual-target position when the head (and gaze) remained in a straight-ahead position. This accuracy was preserved when subjects voluntary rotated the head by various magnitudes in the direction of the memorized visual target (head rotations ranged between 5 degrees and 60 degrees). However, when the chair on which the subjects were seated was unexpectedly rotated about the yaw axis in the direction of the target (chair rotations ranged between 6 degrees and 36 degrees ) during the head-on-trunk rotations, the performance was markedly decreased, both in terms of spatial precision (mean error=5.6 degrees ) and variability (mean=5.7 degrees). A control experiment showed that the prior knowledge of chair rotation occurrence had no effect on the perceived target position after head-trunk movements. Updating an earth-fixed target position during head-on-trunk rotations could be achieved through both cervical and vestibular signals processing, but, in the present experiment, the vestibular output was the only signal that had the potentiality to contribute to accurate coding of the target position after simultaneous head and trunk movements. Our results therefore suggest that the vestibular output is a noisy signal for the central nervous signal to update the visual space during head-in-space motion.

Adaptation in visuomanual tracking depends on intact proprioception.

The role of arm proprioception in motor learning was investigated in experiments in which, by moving the arm, subjects followed the motion of a target displayed on a monitor screen. Adaptive capabilities were tested in visuomanual tracking tasks following alterations in the relationship between the observer's actual arm movement and visual feedback of the arm movement given by a cursor motion on the screen. Tracking performance and adaptive changes, measured in terms of spatiotemporal error, tracking trajectory curvature, and spatial gain, were compared in 7 control subjects (CSs) and in 1 deafferented subject (DS). CSs adapted appropriately to altered visuomanual relationships; those changes were present in trials immediately after restoration of normal scaling. In contrast, although the DS modified his tracking strategy from trial to trial according to the altered conditions, he did not show plastic changes in internal visuomanual scaling. Like the results of prismatic adaptation experiments, the present results suggest that arm proprioception contributes to the plastic changes that follow alterations in the scaling of visuomanual gain.