Axial rotation in Parkinson's disease.

AIMS: To investigate the ability of patients with Parkinson's disease to perform a rotation around the longitudinal axis of the body. Three questions were raised. Is body rotation impaired in Parkinson's disease? Is there a level of the kinematic chain from the head to the foot at which the impairment is more severe? Is the deficit related to the general slowness of movement in Parkinson's disease? METHODS: Kinematic data were recorded. The temporal organisation of body rotation during gait initiation was analysed in 10 patients with Parkinson's disease, who were all at an advanced stage of the disease and had all experienced falls and freezing during their daily life, and in five controls. The latency of the onset of the rotation of each segment was measured by taking the onset of the postural phase of step initiation as reference value. Locomotor variables were also analysed. RESULTS: Body rotation was found to be impaired in patients with Parkinson's disease, as the delay in the onset of the rotation of each segment is greater than that in controls. Moreover, a specific uncoupling in the onset of shoulder and pelvis segment rotation was seen in patients. This impairment of rotation is not related only to the general slowness of movements. CONCLUSION: Patients with Parkinson's disease were found to have an impairment of posturo-kinetic coordination and impaired capacity to exert appropriate ground reaction forces to orient the pelvis in space.

Hip stabilization and lateral balance control in toddlers during the first four months of autonomous walking.

The main purpose of the present paper was to investigate the inter-segmental coordinations between hip, shoulder and head, in toddlers, during the first four months of autonomous walking. The efficiency of locomotor balance control was examined in the frontal plane. The main result to emerge from this study is that the hip stabilization in space appears as soon as the first week of autonomous walking, while shoulder stabilization in space appears to be effective only at the second month. Finally, no preferred head stabilization, either in space or on shoulders, has appeared by the end of the fourth month. These results seem to indicate, from an early hip stabilization, an ascending progression with age of the ability to control lateral balance during locomotion.

Is the trunk a reference frame for calculating leg position?

Naive subjects and dancers were instructed to raise a leg laterally toward 45 degrees. The final position reached by the leg by each group of subjects was quite different: 48 degrees in dancers, i.e. close to the required value, and 56 degrees in the naive subjects. The reason for this difference was investigated. During the body weight transfer toward the supporting side prior to the leg movement, naive subjects inclined both leg and trunk laterally, whereas the dancers' trunk remained vertical. It was observed that in naive subjects the trunk inclination and the overestimation of the final leg position were closely correlated. The results suggest that in both naive subjects and dancers, the trunk axis serves as a reference value for calculating the leg position.

Preparatory postural adjustments in parkinsonian patients with postural instability.

BACKGROUND: Postural instability is a common problem in patients with Parkinson's disease. This paper reports results of a study undertaken to investigate some of the possible mechanisms responsible for this instability. METHODS: Preparatory postural adjustments associated with a lateral leg raising task were studied in five parkinsonian patients and four age-matched controls. Recordings included ground reaction forces, kinematics, and surface EMG activity from multiple leg muscles. RESULTS: In normal subjects there was a well-defined sequence of events preceding the onset of leg elevation, beginning with a transfer of centre of foot pressure (CP), initially toward the moving leg and then back to the support side, followed by displacement of the trunk toward the support side. In the more severely affected parkinsonian patients, the amplitude of the initial displacement of CP was markedly reduced. The interval between the earliest force changes and the onset of leg elevation was prolonged and the relative timing of the kenematic adjustments during this interval was disrupted. In addition the alternating burst and periods of inhibition observed in the EMG recordings from the normal subjects were replaced by continuous tonic EMG activity. CONCLUSIONS: These observations suggest that abnormalities in programming preparatory postural adjustments may contribute to postural instability in some patients with advanced Parkinson's disease.

Organization of lateral balance control in toddlers during the first year of independent walking.

The authors of the present study tested the hypothesis that toddlers initiate lateral body stabilization first at the hip level in order to better control the center of gravity (CG), minimize the upper body destabilization induced by the movement of the feet, and prevent falls. Intersegmental coordination among the hip, the shoulder, and the head was investigated in toddlers during their 1st year of independent walking. The efficiency of locomotor balance control was examined in the frontal plane. An automatic optical TV image processor (ELITE system) was used in analyzing the kinematics of foot, hip, shoulder, and head rotations. For the hip, the shoulder, and the head, appropriate anchoring indices were defined so that comparisons could be made concerning the stabilization of a given body segment with respect to its external space and to the adjacent supporting anatomical segment. Cross-correlation functions were also used for extracting the temporal patterns of the body segments that occurred during locomotion and for obtaining some information about the coupling of 2 consecutive segments such as the head-shoulder and the shoulder-hip. First, hip stabilization in space appeared from the 1st week of independent walking and clearly preceded those of the shoulder and the head, suggesting an ascending progression, with age, in the ability of new walkers to control lateral balance during locomotion. Second, the hip movements occurred before the shoulder movements and the shoulder movements before the head movements, indicating that locomotor balance control is organized temporally in an ascending fashion, from the hip to the head. Third, the high values of the correlation coefficients, mainly between the head and the shoulder, were consistent with a global en bloc operation of the head-trunk unit.

[Quantitative approach of postural asynergia in cerebellar diseases]. / Approche quantitative de l'asynergie posturale en pathologie cérébelleuse.

In his original description of cerebellar asynergia, Babinski, in 1899, presented a patient with cerebellar dysfunction performing a backward upper trunk bending. When the patient tried to bend his head and trunk, his lower limbs stayed almost motionless, because the associated flexion of the knee and hip, usually observed in a normal subject, did not take place. To reassess the possibility that asynergia may actually be a symptom of cerebellar dysfunction, a combined kinematic and electromyographic (EMG) analysis of the upper-trunk bending was performed on 3 patients suffering from progressive cerebellar ataxia of late onset and showing a significant atrophy of the vermis on MRI examination. Compared with 3 age and sex-matched control subjects, a significant slowing down of the upper-trunk displacement and a marked reduction of the associated displacement of hip and knee was observed. EMG recordings of three pairs of antagonistic muscles at trunk level (rectus abdominis, erectores spinae), at thigh level (vastus lateralis, semi membranosus), and at leg level (tibialis anterior, gastrocnemius lateralis), showed that the reciprocal activation pattern characteristic of a normal fast movement was absent at the thigh level in the cerebellar patients. This lack of reciprocal activation of the thigh muscles during the upper-trunk bending might explain the reduction of the compensatory displacement of the hip and knee. It might also represent an essential feature of cerebellar dysfunction in provoking axial asynergia between the upper-trunk, which is the moving segment, and the leg, which is the supporting segment during equilibrium control and during whole body displacement.

Forward versus backward oriented stepping movements in Parkinsonian patients.

The primary purpose of this paper was to compare the effect of reversing the direction of step initiation in Parkinson's disease. Forward (FDS) and backward (BDS) oriented stepping initiation analyses were conducted on combined kinematic and kinetic data recorded on Parkinsonian patients (PD) and healthy age-matched subjects. Two successive phases were examined: a postural phase from T1 (onset of the center of pressure [CP] displacement) to T2 (onset of the malleolus displacement), which was followed by a stepping phase from T2 to T3 (end of the malleolus displacement; i.e., the end of the step). In healthy subjects, the duration of the postural phase remained unchanged regardless of the direction in which the step was initiated. The stepping phase duration and the first step length were reduced in BDS in comparison with FDS. In both tasks, the absolute value of the horizontal force in sagittal plane (Fx) remained unchanged. The maximal velocity of the iliac crest marker (estimated whole body center of gravity [CG]) in the sagittal plane (Vmax CG) remained within the same range regardless of direction of stepping. In Parkinsonian patients, the duration of the postural phase was markedly prolonged in both tasks in comparison with healthy subjects. The mean duration of stepping phase was approximately the same as in normal subjects, but the first step length was considerably reduced, as were horizontal force (Fx) and Vmax CG. This impairment, which was due to a decrease in the propulsive forces, was significantly more pronounced in BDS that in FDS.

Coordination between equilibrium and head-trunk orientation during leg movement: a new strategy build up by training.

1. During unilateral leg movements performed while standing, it is necessary to displace the center of gravity toward the other leg to maintain equilibrium. In addition, the orientation of particular segments, such as the head and trunk, which are used as reference values for organizing the motor act, needs to be preserved. The aim of the present study was to investigate the coordination between movement, equilibrium, and local posture. 2. Experiments were carried out on standing subjects who were instructed to raise one leg laterally to an angle of 45 degrees in response to a light. Two sources of light placed in front of the subject indicated the side on which the movement was to be performed. Three main aspects of the posturokinetic sequence were investigated in two populations, naive subjects and dancers: 1) The body weight transfer toward the supporting leg was found to have two components: first, a "ballistic" one, initiated by a thrust exerted by the moving leg; and second, an "adjustment" component during which the displacement of the center of gravity (CG) reaches a final position (steady state). An early burst in the gastrocnemius medialis of the moving leg often precedes the onset of the center of pressure change. Two differences between naive subjects and dancers were observed: first, the new CG position was almost reached in one step very near to the end of the ballistic component and required only a short adjustment in dancers, whereas in naive subjects it was reached in two steps, including a much longer adjustment component. Second, the dancers were able to minimize the CG displacement toward the supporting side; this might be because they form a better internal representation of the biomechanical limits of stability because of their long training. 2) The onset of the lateral displacement of the malleolus marker of the moving leg always occurred when the body weight had almost completed its transfer to above the support foot. This shows that the positioning of the CG in a new position compatible with equilibrium maintenance was a prerequisite for the leg movement to be performed. The relative timing of events during the posturokinetic sequence was fairly fixed in the dancers, whereas it varied from one trial to another in the naive subjects. 3) The coordination between movement, equilibrium, and head-trunk orientation involves two control strategies. An "inclination" strategy was used by the naive subjects; this consisted of an external rotation of the supporting leg around the anteroposterior ankle joint axis. A counter-rotation at the neck level ensured the stability of the interorbital line in the horizontal plane.(ABSTRACT TRUNCATED AT 400 WORDS)

Impairment of posturo-kinetic co-ordination during initiation of forward oriented stepping movements in parkinsonian patients.

In order to differentiate between a specific impairment affecting gait initiation and a non-specific deficit in the postural adjustment which occurs prior to any forward oriented stepping movement, 3 forward oriented movements (FOMs), performed by a group of parkinsonian patients and a group of healthy age-matched subjects, were compared in the present study. These FOMs all consisted of initiating 1 step, but differed in their respective planning characteristics. The first consisted of initiating normal walking. The second consisted of initiating a single step, while the third was a visually guided task, consisting of placing the foot just behind a mark on the ground. In all 3 FOMs, the postural phase, i.e., the time elapsing between the initial shift of the center of pressure (CP) and the onset of the first step, was significantly longer in the patients than in the healthy subjects, whereas the duration of the subsequent movement phase, i.e., that of the first step, was within the same range in both groups. The horizontal reaction forces that led to a forward center of gravity (CG) acceleration during the postural phase were markedly reduced in the patients in all 3 FOMs, and the maximal velocity of the iliac crest marker, which corresponds approximately to that of the CG, decreased significantly in the patients. In addition, the length of the first step was significantly shorter in the patients than in the healthy subjects, in all 3 FOMs. The EMG pattern differed significantly between the patients and the healthy subjects; the amplitudes of the early tibialis anterior (TA) and vastus lateralis (VL) activations often decreased and were unilateral rather than bilateral. In addition, the gastrocnemius medialis (GM) burst associated with foot lift-off at the end of the postural phase was either absent or greatly reduced, thus suggesting that the co-ordination between the preparatory postural adjustment of the whole body and the actual stepping movement was impaired. The present results suggested that the lengthening of the postural phase is a common deficit in all FOM tasks in parkinsonian patients and is due to the impaired production of the requisite propulsive forces providing the forward acceleration of the CG. Consequently, a shortening of the first step length occurs. However, the step length is reduced less in the FOM tasks which provide some information about the goal of the first step (single step, visually guided step) than in a normal walking task, during which such information is missing. This suggests that although the stepping movement can be improved with the aid of any sensory cue about the end of the step in patients with Parkinson's disease, the postural phase will always be prolonged whichever FOM task they perform.

[Strategies for simultaneous control of the equilibrium and of the head position during the raising movement of a leg]. / Stratégies de contrôle simultané de l'équilibre et de la position de la tête pendant l'élévation d'une jambe.

The coordination between equilibrium control and the ability to maintain the position of given segments (head, trunk) was studied in standing subjects, instructed to raise one leg laterally at an angle of 45 degrees in response to a light. Two sources of light placed at eye level indicated the side on which the movement was to be performed. Two populations were compared: naive subjects and dancers. Two control strategies were identified. An "inclination" strategy was used by the naive subjects. This consisted of an external rotation of the body around the antero-posterior ankle joint axis; a counter-rotation of the head with respect to the trunk was observed, which ensured some stabilization in the horizontal plane of the interorbital line. A "translation" strategy was used by the dancers. Here the external rotation of the leg around the ankle joint was associated with a feed-forward counter-rotation of the trunk around the coxofemoral joint so that the horizontality of the interorbital line and the verticality of the trunk axis were maintained. This new coordination results from a long-term training and indicates that a new motor program has been elaborated.

Lateral leg raising in patients with Parkinson's disease: influence of equilibrium constraint.

Patients with Parkinson's disease often have difficulty maintaining postural stability. This impairment is attributed to postural adjustment deficits. We studied the postural adjustments associated with the performance of two complex tasks which differed only in the final equilibrium constraints. Ten patients with Parkinson's disease and six age-matched control subjects were asked to raise one leg laterally to an abduction angle of approximately 45 degrees as fast as possible to the right or left in random order. In the first series of tests, the subjects were instructed to maintain the leg at 45 degrees, whereas in the second series they were instructed to place their foot back on the ground. Recordings included ground reaction forces and kinematics. In the patients with Parkinson's disease the final posture for the first task was never maintained. The strategy used to shift the body weight was different for the two groups. In control subjects, it was initiated by a whole body rotation around the ankle followed by a trunk inclination around the hip. Conversely, in patients with Parkinson's disease, the shift of the body weight was initiated by a trunk inclination around the hip and then by a whole body rotation around the ankle. The amplitude of the trunk inclination toward the supporting side was smaller than in the control subjects. The second task with less severe equilibrium constraints was, on the whole, better performed by the patients even though the same postural adjustment deficits were present.

Axial synergies in parkinsonian patients during voluntary trunk bending.

During upper trunk movements, the axial kinematic synergies (opposite movements of upper and lower segments) preserve the balance by minimizing the antero-posterior center of gravity (CG) shift due to the movement. Forward and backward upper trunk movements were analyzed in a population of parkinsonian patients (PD) that were subject to falling, in order to determine whether an impaired control of the kinematic synergies might explain the falling. Ten PD (stage III-IV of the Hoehn and Yahr classification; Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17;427-432) were compared to seven age-matched control subjects (CS). Kinematic analysis and force platform recordings were carried out. Principal Component (PC) analysis was performed to measure the coupling between hip, knee and ankle joint angles during the movement. (1) In both PD and CS, the first principal component (PC1) was found to account for 98% or more of the joint angles changes, which indicates that there exists a strong coupling between the angles during the movement; however, the part of the movement not accounted for by PC1 was twice as high in PD as in CS. (2) The intertrial variability between the angle ratios was about twice as high in PD as in CS. (3) The absolute value of the antero-posterior CG shift occurring during the movement significantly increased in PD in the case of backward movements, both fast and slow. (4) As a high correlation was found between actual CG shift and its estimation based on the observed interjoint coordination, the increased CG shift in PD was related to unproper set of ratios between joint angles. It was concluded that the control of the kinematic synergy is preserved on the whole in PD, with an increased variability and unproper set of the ratios between joint angular changes. This may lead to CG shifts to beyond the support surface, especially in backward bending. Copyright 1998 Elsevier Science B.V.