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Objective: To compare the scaling of the postural stability variables between older nonfallers and fallers during gait initiation (GI) while stepping over increasing obstacle distances., Design: Cross-sectional study., Setting: University research laboratory., Participants: A sample of participants (N=24) divided into 2 groups: older nonfallers (n=12) and older fallers (n=12). Participants had no known neurologic, musculoskeletal, or cardiovascular conditions that could have affected their walking, and all were independent walkers. All the participants had an adequate cognitive function to participate as indicated by a score of more than 24 on the Mini-Mental State Examination., Interventions: Not applicable., Main Outcome Measures: The primary dependent variables were peak anterior-posterior (AP) center of mass (CoM)-center of pressure (CoP) separation during anticipatory postural adjustments (APAs), AP CoM-CoP separation at the toe-off, and peak AP CoM-CoP separation during the swing. Secondary dependent variables were AP trunk angle during GI. Within- and between-repeated measures analysis of variance was used to compare means between groups across different task conditions for all the dependent variables., Results: There was a main effect of group for peak AP CoM-CoP separation during APA (P=.018), an interaction effect between group and condition for AP CoM-CoP separation at toe-off (P=.009), and a main effect of condition for peak AP CoM-CoP separation during the swing (P<.001). We also found a main effect of group for peak AP trunk angle during the swing (P=.028)., Conclusions: For GI while stepping over increasing obstacle distances, older fallers adopt a more conservative strategy of AP CoM-CoP separation than nonfallers prior to toe-off and demonstrate increased peak AP trunk lean during the swing. AP CoM-CoP separation prior to toe-off during the GI task may be a critical marker to identify fallers and warrants additional investigation., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine how concussion may impair sensory processing for control of upright stance., Methods: Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1 years) with a history of concussion (concussion history group, > 1 year post-injury), and 26 participants (8 women, 22 ± 3 years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ± 1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28 Hz., Results: The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting., Conclusion: Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: To assess the effects of the initial stepping limb on posterior fall recovery in individuals with chronic stroke, as well as to determine the benefits of fall-recovery training on these outcomes., Methods: This was a single-group intervention study of 13 individuals with chronic stroke. Participants performed up to six training sessions, each including progressively challenging, treadmill-induced perturbations from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. The highest perturbation level achieved, the proportion of successful recoveries, step and trunk kinematics, as well as stance-limb muscle activation about the ankle were compared between the initial stepping limbs in the first session. Limb-specific outcomes were also compared between the first and last training sessions., Findings: In the first session, initial steps with the non-paretic limb were associated with a higher proportion of success and larger perturbations than steps with the paretic limb (p = 0.02, Cohen's d = 0.8). Paretic-limb steps were wider relative to the center of mass (CoM; p = 0.01, d = 1.3), likely due to an initial standing position with the CoM closer to the non-paretic limb (p = 0.01, d = 1.4). In the last training session, participants recovered from a higher proportion of perturbations and advanced to larger perturbations (p < 0.05, d > 0.6). There were no notable changes in kinematic or electromyography variables with training (p > 0.07, d < 0.5)., Interpretation: The skill of posterior stepping in response to a perturbation can be improved with practice in those with chronic stroke, we were not able to identify consistent underlying kinematic mechanisms behind this adaptation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The purpose of this study was to compare sensory reweighting for upright stance between soccer players who report higher soccer heading exposure to those who report lower soccer heading exposure. Thirty participants completed a self-reported questionnaire to estimate the number of soccer headers experienced over the previous year and were divided into "low exposure" and "high exposure" groups based on their responses. Sensory reweighting for upright stance was assessed by simultaneously perturbing visual, vestibular, and proprioceptive systems. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ±1mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, and the proprioceptive stimulus was Achilles tendon vibration at 0.28 Hz. The visual stimulus was presented at two amplitudes (0.2 m, 0.8 m). Center of mass (COM) gain/phase to each modality, total power, 95% area and velocity were compared between low exposure (N = 15, six males, 21.5 ± 1.9 years, 27.7 ± 31.6 headers) and high exposure groups (N = 15, 10 males, 22.1 ± 3.5years, 734.9 ± 877.7 headers). Without vibration, COM 95% area (F = 5.861, p  = 0.022*, partial η 2  = 0.173), velocity (F = 14.198, p  = 0.001, partial η 2  = 0.336), and total power (F = 13.491, p  = 0.001, partial η 2  = 0.325) for the "high exposure" group were higher than for the "low exposure" group, and postural sway lagged the vestibular stimulus in the "high exposure" group rather than leading it as in the "low exposure" group (F = 4.765, p  = 0.038, partial η 2  = 0.145). There were no differences in sensory reweighting and no differences in COM gain/phase between groups. These findings lend empirical evidence to a detrimental effect of soccer heading exposure on balance control during upright stance.

US Soccer eliminated soccer heading for youth players ages 10 years and younger and limited soccer heading for children ages 11-13 years. Limited empirical evidence associates soccer heading during early adolescence with medium-to-long-term behavioral deficits. The purpose of this study was to compare sensory reweighting for upright stance between college-aged soccer players who began soccer heading ages 10 years and younger (AFE ≤ 10) and those who began soccer heading after age 10 (AFE > 10). Thirty soccer players self-reported age of first exposure (AFE) to soccer heading. Sensory reweighting was compared between AFE ≤ 10 and AFE > 10. To evaluate sensory reweighting, we simultaneously perturbed upright stance with visual, vestibular, and proprioceptive stimulation. The visual stimulus was presented at two different amplitudes to measure the change in gain to vision, an intra-modal effect; and change in gain to galvanic vestibular stimulus (GVS) and vibration, both inter-modal effects. There were no differences in gain to vision (p=0.857, η2=0.001), GVS (p=0.971, η2=0.000), or vibration (p=0.974, η2=0.000) between groups. There were no differences in sensory reweighting for upright stance between AFE ≤ 10 and AFE > 10, suggesting that soccer heading during early adolescence is not associated with balance deficits in college-aged soccer players, notwithstanding potential deficits in other markers of neurological function., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: To study the effects of the initial stepping limb on anterior fall-recovery performance and kinematics, as well as to determine the benefits of fall-recovery training on those outcomes in individuals with chronic stroke., Methods: Single-group intervention of 15 individuals with chronic stroke who performed up to six sessions of fall-recovery training. Each session consisted of two progressions of treadmill-induced perturbations to induce anterior falls from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. Fall-recovery performance (the highest disturbance level achieved and the proportion of successful recoveries), as well as step and trunk kinematics were compared between the initial stepping limbs on the first session. Limb-specific outcomes were also compared between the first and last training sessions., Findings: There were no between-limb differences in fall-recovery performance in the first session. With training, participants successfully recovered from a higher proportion of falls (p's = 0.01, Cohen's d's > 0.7) and progressed to larger perturbation magnitudes (p's < 0.06, d's > 0.5). Initial steps with the paretic limb were wider and shorter relative to the center of mass (p's < 0.06, d's > 0.5). With training, initial paretic-limb steps became longer relative to the CoM (p = 0.03, d = 0.7). Trunk forward rotation was reduced when first stepping with the non-paretic limb (p = 0.03, d = 0.6)., Interpretation: The initial stepping limb affects relevant step kinematics during anterior fall recovery. Fall-recovery training improved performance and select kinematic outcomes in individuals with chronic stroke., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The present study aimed to investigate the sensitivity of detecting lower limb passive motion and use of additional sensory information from fingertip light touch for the postural control of older adults in comparison with young adults. A total of 11 older and 11 young adults (aged 68.1 ± 5.2 and 24.2 ± 2.2 years, respectively) underwent two tasks. We evaluated their sensitivity to passive ankle joint movement while seated in the first task. Participants then stood quietly on a force plate in a semi-tandem stance, for 30 s under two fingertip contact force conditions (no touch and light touch limited to 1 N). The results showed that the threshold of passive ankle displacement and body sway is higher in older adults than in young adults. The body sway reduced for both older and young adults with the addition of light touch at the fingertips. The maximum cross-correlation coefficient and time lags between body sway and fingertip light touch center of pressure was similar between both groups, suggesting that older adults used light touch to reduce body sway, similar to young adults. A higher threshold in detecting passive ankle joint movement may contribute to the increased body sway observed in older adults. These deficits may be compensated by additional sensory cues that would provide enhanced information used to control the upright stance., (Copyright © 2018. Published by Elsevier B.V.)

Background and Purpose: Multisensory reweighting (MSR) deficits in older adults contribute to fall risk. Sensory-challenge balance exercises may have value for addressing the MSR deficits in fall-prone older adults. The purpose of this study was to examine the effect of sensory-challenge balance exercises on MSR and clinical balance measures in fall-prone older adults., Methods: We used a quasi-experimental, repeated-measures, within-subjects design. Older adults with a history of falls underwent an 8-week baseline (control) period. This was followed by an 8-week intervention period that included 16 sensory-challenge balance exercise sessions performed with computerized balance training equipment. Measurements, taken twice before and once after intervention, included laboratory measures of MSR (center of mass gain and phase, position, and velocity variability) and clinical tests (Activities-specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, Limits of Stability test, and lower extremity strength and range of motion)., Results: Twenty adults 70 years of age and older with a history of falls completed all 16 sessions. Significant improvements were observed in laboratory-based MSR measures of touch gain (P = 0.006) and phase (P = 0.05), Berg Balance Scale (P = 0.002), Sensory Organization Test (P = 0.002), Limits of Stability Test (P = 0.001), and lower extremity strength scores (P = 0.005). Mean values of vision gain increased more than those for touch gain, but did not reach significance., Discussion and Conclusions: A balance exercise program specifically targeting multisensory integration mechanisms improved MSR, balance, and lower extremity strength in this mechanistic study. These valuable findings provide the scientific rationale for sensory-challenge balance exercise to improve perception of body position and motion in space and potential reduction in fall risk.

Lateral balance is a critical factor in keeping the human body upright during walking. Two important mechanisms for balance control are the stepping strategy, in which the foot placement is changed in the direction of a sensed fall to modulate how the gravitational force acts on the body, and the lateral ankle strategy, in which the body mass is actively accelerated by an ankle torque. Currently, there is minimal evidence about how these two strategies complement one another to achieve upright balance during locomotion. We use Galvanic vestibular stimulation (GVS) to induce the sensation of a fall at heel-off during gait initiation. We found that young healthy adults respond to the illusory fall using both the lateral ankle strategy and the stepping strategy. The stance foot center of pressure (CoP) is shifted in the direction of the perceived fall by ≈2.5 mm, starting ≈247 ms after stimulus onset. The foot placement of the following step is shifted by ≈15 mm in the same direction. The temporal delay between these two mechanisms suggests that they independently contribute to upright balance during locomotion, potentially in a serially coordinated manner. Modeling results indicate that without the lateral ankle strategy, a much larger step width is required to maintain upright balance, suggesting that the small but early CoP shift induced by the lateral ankle strategy is critical for upright stability during locomotion. The relative importance of each mechanism and how neurological disorders may affect their implementation remain an open question.

Current thinking views mild head impact (i.e., subconcussion) as an underrecognized phenomenon that has the ability to cause significant current and future detrimental neurological effects. Repeated mild impacts to the head, however, often display no observable behavioral deficits based on standard clinical tests, which may lack sensitivity. The current study investigates the effects of subconcussive impacts from soccer heading with innovative measures of vestibular function and walking stability in a pre- 0-2 h, post- 24 h post-heading repeated measures design. The heading group (n = 10) executed 10 headers with soccer balls projected at a velocity of 25 mph (11.2 m/sec) over 10 min. Subjects were evaluated 24 h before, immediately after, and 24 h after soccer heading with: the modified Balance Error Scoring System (mBESS); a walking stability task with visual feedback of trunk movement; and galvanic vestibular stimulation (GVS) while standing with eyes closed on foam. A control group (n = 10) followed the same protocol with no heading. The results showed significant decrease in trunk angle, leg angle gain, and center of mass gain relative to GVS for the heading group compared with controls. Medial-lateral trunk orientation displacement and velocity during treadmill walking increased immediately after mild head impact for the heading group compared with controls. Controls showed an improvement in mBESS scores over time, indicating a learning effect, which was not observed with the heading group. These results suggest that mild head impact leads to a transient dysfunction in vestibular processing, which deters walking stability during task performance., Competing Interests: Author Disclosure Statement John Jeka is one of the inventors of the sensory treadmill described in this experiment. United States Patent# 8,900,165. For the remaining authors, no competing financial interests exist.

Parkinson's disease (PD) is a progressive degenerative disease manifested by tremor, rigidity, bradykinesia, and postural instability. Deficits in proprioceptive integration are prevalent in individuals with PD, even at early stages of the disease. These deficits have been demonstrated primarily during investigations of reaching. Here, we investigated how PD affects sensory fusion of multiple modalities during upright standing. We simultaneously perturbed upright stance with visual, vestibular, and proprioceptive stimulation, to understand how these modalities are reweighted so that overall feedback remains suited to stabilizing upright stance in individuals with PD. Eight individuals with PD stood in a visual cave with a moving visual scene at 0.2 Hz while an 80-Hz vibratory stimulus was applied bilaterally to their Achilles tendons (stimulus turns on-off at 0.28 Hz) and a ±1 mA bilateral monopolar galvanic stimulus was applied at 0.36 Hz. The visual stimulus was presented at different amplitudes (0.2°, 0.8° rotation about ankle axis) to measure: the change in gain (weighting) to vision, an intramodal effect; and a simultaneous change in gain to vibration and galvanic stimulation, both intermodal effects. Trunk/leg gain relative to vision decreased when visual amplitude was increased, reflecting an intramodal visual effect. In contrast, when vibration was turned on/off, leg gain relative to vision was equivalent in individuals with PD, indicating no reweighting of visual information when proprioception was disrupted through vibration (i.e., no intermodal effect). Trunk and leg angle gain relative to GVS also showed no reweighting in individuals with PD. These results are in contrast to previous results with healthy adults, who showed clear intermodal effects in the same paradigm, suggesting that individuals with PD not only have a proprioceptive deficit during standing, but also have a cross-modal sensory fusion deficit that is crucial for upright stance control.

The aim of this study was to investigate the effects of explicit and implicit knowledge about visual surrounding manipulation on postural responses. Twenty participants divided into two groups, implicit and explicit, remained in upright stance inside a "moving room". In the fourth trial participants in the explicit group were informed about the movement of the room while participants in the implicit group performed the trial with the room moving at a larger amplitude and higher velocity. Results showed that postural responses to visual manipulation decreased after participants were told that the room was moving as well as after increasing amplitude and velocity of the room, indicating decreased coupling (down-weighting) of the visual influences. Moreover, this decrease was even greater for the implicit group compared to the explicit group. The results demonstrated that conscious knowledge about environmental state changes the coupling to visual information, suggesting a cognitive component related to sensory re-weighting. Re-weighting processes were also triggered without awareness of subjects and were even more pronounced compared to the first case. Adaptive re-weighting was shown when knowledge about environmental state was gathered explicitly and implicitly, but through different adaptive processes., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

We simultaneously perturbed visual, vestibular and proprioceptive modalities to understand how sensory feedback is re-weighted so that overall feedback remains suited to stabilizing upright stance. Ten healthy young subjects received an 80 Hz vibratory stimulus to their bilateral Achilles tendons (stimulus turns on-off at 0.28 Hz), a ± 1 mA binaural monopolar galvanic vestibular stimulus at 0.36 Hz, and a visual stimulus at 0.2 Hz during standing. The visual stimulus was presented at different amplitudes (0.2, 0.8 deg rotation about ankle axis) to measure: the change in gain (weighting) to vision, an intramodal effect; and a change in gain to vibration and galvanic vestibular stimulation, both intermodal effects. The results showed a clear intramodal visual effect, indicating a de-emphasis on vision when the amplitude of visual stimulus increased. At the same time, an intermodal visual-proprioceptive reweighting effect was observed with the addition of vibration, which is thought to change proprioceptive inputs at the ankles, forcing the nervous system to rely more on vision and vestibular modalities. Similar intermodal effects for visual-vestibular reweighting were observed, suggesting that vestibular information is not a "fixed" reference, but is dynamically adjusted in the sensor fusion process. This is the first time, to our knowledge, that the interplay between the three primary modalities for postural control has been clearly delineated, illustrating a central process that fuses these modalities for accurate estimates of self-motion.

A fundamental issue in motor control is how to determine the task goals for a given behavior. Here, we address this question by separately identifying the musculoskeletal and feedback components of the human postural control loop. Eighteen subjects were perturbed by two mechanical perturbations (gentle pulling from behind at waist and shoulder levels) and one sensory perturbation (movement of a virtual visual scene). Body kinematics was described by the leg and trunk segment angles in the sagittal plane. Muscle activations were described by ankle and hip EMG signals, with each EMG signal computed as a weighted sum of rectified EMG signals from multiple muscles at the given joint. The mechanical perturbations were used to identify feedback, defined as the mapping from the two segment angles to the two EMG signals. The sensory perturbation was used to estimate parameters in a mechanistic model of the plant, defined as the mapping from the two EMG signals to the two segment angles. Using the plant model and optimal control theory, we compared identified feedback to optimal feedback for a range of cost functions. Identified feedback was similar to feedback that stabilizes upright stance with near-minimum muscle activation, but was not consistent with feedback that substantially increases muscle activation to reduce movements of the body's center of mass or center of pressure. The results suggest that the common assumption of reducing sway may not apply to musculoskeletal systems that are inherently unstable.

In two experiments, the ability to use multisensory information (haptic information, provided by lightly touching a stationary surface, and vision) for quiet standing was examined in typically developing (TD) children, adults, and in seven-year-old children with Developmental Coordination Disorder (DCD). Four sensory conditions (no touch/no vision, with touch/no vision, no touch/with vision, and with touch/with vision) were employed. In experiment 1, we tested four-, six- and eight-year-old TD children and adults to provide a developmental landscape for performance on this task. In experiment 2, we tested a group of seven-year-old children with DCD and their age-matched TD peers. For all groups, touch robustly attenuated standing sway suggesting that children as young as four years old use touch information similarly to adults. Touch was less effective in children with DCD compared to their TD peers, especially in attenuating their sway velocity. Children with DCD, unlike their TD peers, also benefited from using vision to reduce sway. The present results suggest that children with DCD benefit from using vision in combination with touch information for standing control possibly due to their less well developed internal models of body orientation and self-motion. Internal model deficits, combined with other known deficits such as postural muscles activation timing deficits, may exacerbate the balance impairment in children with DCD., (Copyright © 2011 Elsevier B.V. All rights reserved.)

To control upright stance, the human nervous system must estimate the movements of multiple body segments based on multisensory information. To investigate how visual information contributes to such multisegmental estimation, participants were exposed to 3 types of visual-scene movement: translation in the anteroposterior direction, rotation about the ankle joint, and rotation about the hip joint. Trunk and leg responses were larger for rotational than for translational movements, but only at lower stimulus frequencies. Based on a feedback-control theoretical framework, these results indicated that visual inputs distinguish between translation and rotation of the head. Also, visual condition effects were similar for the leg and trunk segments, suggesting a control strategy with a single control signal that determines the activation of all muscles., (Copyright © Taylor & Francis Group, LLC)

Vision can improve bipedal upright stability during standing and locomotion. However, during locomotion, vision supports additional behaviors such as gait cycle modulation, navigation, and obstacle avoidance. Here, we investigate how the multiple roles of vision are reflected in the dynamics of trunk control as the neural control problem changes from a fixed to a moving base of support. Subjects were presented with either low- or high-amplitude broadband visual stimuli during standing posture or while walking on a treadmill at 1 km/h and 5 km/h. Frequency response functions between visual scene motion (input) and trunk kinematics (output) revealed little or no change in the gain of trunk orientation in the standing posture and walking conditions. However, a dramatic increase in gain was observed in trunk (hip and shoulder) horizontal displacement from posture to locomotion. Such increases in gain may be interpreted as an increased coupling to visual scene motion. However, we believe that the increased gain reflects a decrease in stability due to a change of the control problem from standing to locomotion. Indeed, keeping the body upright with the use of vision during walking is complicated by the additional locomotor processes at work. Unlike during standing, vision plays many roles during locomotion, providing information for upright stability as well as body position relative to the external environment.

Multisensory reweighting (MSR) is an adaptive process that prioritizes the visual, vestibular, and somatosensory inputs to provide the most reliable information for postural stability when environmental conditions change. This process is thought to degrade with increasing age and to be particularly deficient in fall-prone versus healthy older adults. In the present study, the authors investigate the dynamics of sensory reweighting, which is not well-understood at any age. Postural sway of young, healthy, and fall-prone older adults was measured in response to large changes in the visual motion stimulus amplitude within a trial. Absolute levels of gain, and the rate of adaptive gain change were examined when visual stimulus amplitude changed from high to low and from low to high. Compared with young adults, gains in both older adult groups were higher when the stimulus amplitude was high. Gains in the fall-prone elderly were higher than both other groups when the stimulus amplitude was low. Both older groups demonstrated slowed sensory reweighting over prolonged time periods when the stimulus amplitude was high. The combination of higher vision gains and slower down weighting in older adults suggest deficits that may contribute to postural instability.

We determined properties of the plant during human upright stance using a closed-loop system identification method originally applied to human postural control by another group. To identify the plant, which was operationally defined as the mapping from muscle activation (rectified EMG signals) to body segment angles, we rotated the visual scene about the axis through the subject's ankles using a sum-of-sines stimulus signal. Because EMG signals from ankle muscles and from hip and lower trunk muscles showed similar responses to the visual perturbation across frequency, we combined EMG signals from all recorded muscles into a single plant input. Body kinematics were described by the trunk and leg angles in the sagittal plane. The phase responses of both angles to visual scene angle were similar at low frequencies and approached a difference of approximately 150 degrees at higher frequencies. Therefore we considered leg and trunk angles as separate plant outputs. We modeled the plant with a two-joint (ankle and hip) model of the body, a second-order low-pass filter from EMG activity to active joint torques, and intrinsic stiffness and damping at both joints. The results indicated that the in-phase (ankle) pattern was neurally generated, whereas the out-of-phase pattern was caused by plant dynamics. Thus a single neural strategy leads to multiple kinematic patterns. Moreover, estimated intrinsic stiffness in the model was insufficient to stabilize the plant.

Postural control is an important factor for early motor development; however, compared with adults, little is known about how infants control their unperturbed upright posture. This lack of knowledge, particularly with respect to spatial and temporal characteristics of infants' unperturbed independent standing, represents a significant gap in the understanding of human postural control and its development. Therefore, our first analysis offers a thorough longitudinal characterization of infants' quiet stance through the 9 months following the onset of independent walking. Second, we examined the influence of sensory-mechanical context, light touch contact, on infants' postural control. Nine typically developing infants were tested monthly as they stood on a small pedestal either independently or with the right hand lightly touching a stationary contact surface. In addition to the longitudinal study design, an age-constant sample was analyzed to verify the influence of walking experience in infant postural development without the confounding effect of chronological age. Center of pressure excursions were recorded and characterized by distance-related, velocity, and frequency domain measures. The results indicated that, with increasing experience in the upright, as indexed by walk age, infants' postural sway exhibited shifts in rate-related characteristics toward lower frequency and slower, less variable velocity oscillations without changing the spatial characteristics of sway. Additional touch contact stabilized infants' postural sway as revealed by decrease in sway position variance, amplitude, and area as well as lower frequency and velocity. These results were confirmed by the age-constant analysis. Taken together, our findings suggest that instead of progressively reducing the sway magnitude, infants sway differently with increasing upright experience or with additional somatosensory information. These differences suggest that early development of upright stance, particularly as it relates to increasing postural and locomotor experience, involves a refinement of sensorimotor dynamics that enhances estimation of self-motion for controlling upright stance.

Upright stance was perturbed using sinusoidal platform rotations to see how vestibular and somatosensory information are used to control segment and intersegmental dynamics in subjects with bilateral vestibular loss (BVL) and healthy controls (C). Subjects stood with eyes closed on a rotating platform (+/-1.2 degrees) for frequencies ranging from 0.01-0.4 Hz in the presence and absence of light fingertip touch. Trunk movement relative to the platform of BVLs was higher than Cs at higher platform frequencies whereas leg movement relative to the platform was similar for both groups. With the addition of light touch, both groups showed similar trunk and leg segment movement relative to the platform. Trunk-leg coordination was in-phase for frequencies below 1 Hz and anti-phase above 1 Hz. Interestingly, BVLs showed evidence of a "legs-leading-trunk" relationship in the shift from in-phase to anti-phase around 1 Hz. Controls showed no preference for either segment to lead the coordinative shift from in- to anti-phase. The results suggest that the balance instability of BVL subjects stems from high variability of the trunk, rather than the legs. The high trunk variability may emerge from the "legs-leading" intersegmental relationship upon which BVLs rely. Because BVLs derive information about self-orientation primarily from the support surface when their eyes are closed, the legs initiate the shift to anti-phase trunk-leg coordination that is necessary for stable upright stance control. Higher trunk variability suggests that this strategy results in lower overall postural stability. Light touch substitutes for vestibular information, leading to lower trunk variability along with a trunk-leg phase shift similar to controls, without a preference for either segment to lead the shift. The results suggest that vestibulospinal control acts primarily to stabilize the trunk in space and to facilitate intersegmental dynamics.

Reweighting to multisensory inputs adaptively contributes to stable and flexible upright stance control. However, few studies have examined how early a child develops multisensory reweighting ability, or how this ability develops through childhood. The purpose of the study was to characterize a developmental landscape of multisensory reweighting for upright postural control in children 4-10 years of age. Children were presented with simultaneous small-amplitude somatosensory and visual environmental movement at 0.28 and 0.2 Hz, respectively, within five conditions that independently varied the amplitude of the stimuli. The primary measure was body sway amplitude relative to each stimulus: touch gain and vision gain. We found that children can reweight to multisensory inputs from 4 years on. Specifically, intra-modal reweighting was exhibited by children as young as 4 years of age; however, inter-modal reweighting was only observed in the older children. The amount of reweighting increased with age indicating development of a better adaptive ability. Our results rigorously demonstrate the development of simultaneous reweighting to two sensory inputs for postural control in children. The present results provide further evidence that the development of multisensory reweighting contributes to more stable and flexible control of upright stance, which ultimately serves as the foundation for functional behaviors such as locomotion and reaching.

The transition from sitting to walking is a major motor milestone for the developing postural system. This study examined whether this transition to walking impacts the previously established posture (i.e., sitting). Nine infants were examined monthly from sitting onset until 9 months post-walking. Infants sat on a saddle-shape chair either independently or with their right hand touching a stationary contact surface. Postural sway was measured by sway amplitude, variability, area, and velocity of the center of pressure trajectory. The results showed that for all the postural measures in the no-touch condition, a peak before or at walk onset was observed in all the infants. At the transition age, when peak sway occurred, infants' postural sway measures were significantly greater than at any other age. Further, infants' postural sway was attenuated by touch only at this transition. We suggest that this transient disruption in sitting posture results from a process involving re-calibration of an internal model for the sensorimotor control of posture so as to accommodate the newly emerging bipedal behavior of independent walking.

Postural sway is considered to have two fundamental stochastic components, a slow nonoscillatory component and a faster damped-oscillatory component. The slow component has been shown to account for the majority of sway variance during quiet stance. Postural control is generally viewed as a feedback loop in which sway is detected by sensory systems and appropriate motor commands are generated to stabilize the body's orientation. Whereas the mechanistic source for the damped-oscillatory sway component is most likely feedback control of an inverted pendulum, the underlying basis for the slow component is less clear. We investigated whether the slow process was inside or outside the feedback loop by providing standing subjects with sum-of-sines visual motion. Linear stochastic models were fit to the experimental sway trajectories to determine the stochastic structure of sway as well as the transfer function from visual motion to sway. The results supported a fifth-order stochastic model, consisting of a slow process and two damped-oscillatory components. Importantly, the slow process was determined to be inside the feedback loop. This supports the hypothesis that the slow component is due to errors in state estimation because state estimation is inside the feedback loop rather than a moving reference point or an exploratory process outside the feedback loop.

It is well known that the human postural control system responds to motion of the visual scene, but the implicit assumptions it makes about the visual environment and what quantities, if any, it estimates about the visual environment are unknown. This study compares the behavior of four models of the human postural control system to experimental data. Three include internal models that estimate the state of the visual environment, implicitly assuming its dynamics to be that of a linear stochastic process (respectively, a random walk, a general first-order process, and a general second-order process). In each case, all of the coefficients that describe the process are estimated by an adaptive scheme based on maximum likelihood. The fourth model does not estimate the state of the visual environment. It adjusts sensory weights to minimize the mean square of the control signal without making any specific assumptions about the dynamic properties of the environmental motion. We find that both having an internal model of the visual environment and its type make a significant difference in how the postural system responds to motion of the visual scene. Notably, the second-order process model outperforms the human postural system in its response to sinusoidal stimulation. Specifically, the second-order process model can correctly identify the frequency of the stimulus and completely compensate so that the motion of the visual scene has no effect on sway. In this case the postural control system extracts the same information from the visual modality as it does when the visual scene is stationary. The fourth model that does not simulate the motion of the visual environment is the only one that reproduces the experimentally observed result that, across different frequencies of sinusoidal stimulation, the gain with respect to the stimulus drops as the amplitude of the stimulus increases but the phase remains roughly constant. Our results suggest that the human postural control system does not estimate the state of the visual environment to respond to sinusoidal stimuli.

Recent models of human postural control have focused on the nonlinear properties inherent to fusing sensory information from multiple modalities. In general, these models are underconstrained, requiring additional experimental data to clarify the properties of such nonlinearities. Here we report an experiment suggesting that new or multiple mechanisms may be needed to capture the integration of vision into the postural control scheme. Subjects were presented with visual displays whose motion consisted of two components: a constant-amplitude, 0.2 Hz oscillation, and constant-velocity translation from left to right at velocities between 0 cm/s and 4 cm/s. Postural sway variability increased systematically with translation velocity, but remained below that observed in the eyes-closed condition, indicating that the postural control system is able to use visual information to stabilize sway even at translation velocities as high as 4 cm/s. Gain initially increased as translation velocity increased from 0 cm/s to 1 cm/s and then decreased. The changes in gain and variability provided a clear indication of nonlinearity in the postural response across conditions, which were interpreted in terms of sensory reweighting. The fact that gain did not decrease at low translation velocities suggests that the postural control system is able to decompose relative visual motion into environmental motion and self-motion. The eventual decrease in gain suggests that nonlinearities in sensory noise levels (state-dependent noise) may also contribute to the sensory reweighting involved in postural control. These results provide important constraints and suggest that multiple mechanisms may be required to model the nonlinearities involved in sensory fusion for upright stance control.

Summarizes the results of studies showing the influence of light touch contact on postural control of patients with balance disorder. Importance of sensory input from a balance aid; Effects of light touch contact to the body sway; Factors influencing pattern of somatosensory stimulation with hand-held cane; Implications of the use of light touch contact with a cane.