scholarly journals Neurophysiological analysis of the clinical pull test

2018 ◽  
Vol 120 (5) ◽  
pp. 2325-2333
Author(s):  
Joy Lynn Tan ◽  
Thushara Perera ◽  
Jennifer L. McGinley ◽  
Shivanthan Arthur Curtis Yohanandan ◽  
Peter Brown ◽  
...  
Keyword(s):  
Motion Tracking ◽  
Postural Response ◽  
Step Size ◽  
Pull Force ◽  
Pull Test ◽  
Ecological Relevance ◽  
Postural Responses ◽  
Platform Translation ◽  
Different Response ◽  
Startling Stimulus

Postural reflexes are impaired in conditions such as Parkinson’s disease, leading to difficulty walking and falls. In clinical practice, postural responses are assessed using the “pull test,” where an examiner tugs the prewarned standing patient backward at the shoulders and grades the response. However, validity of the pull test is debated, with issues including scaling and variability in administration and interpretation. It is unclear whether to assess the first trial or only subsequent repeated trials. The ecological relevance of a forewarned backward challenge is also debated. We therefore developed an instrumented version of the pull test to characterize responses and clarify how the test should be performed and interpreted. In 33 healthy participants, “pulls” were manually administered and pull force measured. Trunk and step responses were assessed with motion tracking. We probed for the StartReact phenomenon (where preprepared responses are released early by a startling stimulus) by delivering concurrent normal or “startling” auditory stimuli. We found that the first pull triggers a different response, including a larger step size suggesting more destabilization. This is consistent with “first trial effects,” reported by platform translation studies, where movement execution appears confounded by startle reflex-like activity. Thus, first pull test trials have clinical relevance and should not be discarded as practice. Supportive of ecological relevance, responses to repeated pulls exhibited StartReact, as previously reported with a variety of other postural challenges, including those delivered with unexpected timing and direction. Examiner pull force significantly affected the postural response, particularly the size of stepping. NEW & NOTEWORTHY We characterized postural responses elicited by the clinical “pull test” using instrumentation. The first pull triggers a different response, including a larger step size suggesting more destabilization. Thus, first trials likely have important clinical and ecological relevance and should not be discarded as practice. Responses to repeated pulls can be accelerated with a startling stimulus, as reported with a variety of other challenges. Examiner pull force was a significant factor influencing the postural response.

scholarly journals Early Postural Instability in Parkinson’s Disease: A Biomechanical Analysis of the Pull Test

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Javier Ricardo Pérez-Sánchez ◽  
Francisco Grandas
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Healthy Subjects ◽  
Postural Instability ◽  
Biomechanical Analysis ◽  
Stage Iii ◽  
Clinical Test ◽  
Pull Force ◽  
Pull Test ◽  
Postural Responses

Postural instability in Parkinson’s disease (PD) is commonly assessed by the pull test. This clinical test may be biased by the variability of the pull force applied. Our objective was to study the postural responses elicited by reproducible pull forces in healthy subjects and PD patients at different stages of the disease. We performed a multimodal approach that included a systematic analysis of the pull force needed to reach the backward limit of stability (FBLoS) assessed by mechanically produced forces, the displacements of the center of pressure (CoP) recorded on a force platform, and the latencies and patterns of activation of the stabilizing muscles. Comparisons between groups were performed by univariate and multivariate statistical analyses. Sixty-four healthy subjects and 32 PD patients, 22 Hoehn–Yahr (H–Y) stages I-II and 10 H–Y stage III, were studied. In healthy subjects, FBLoS decreased with aging and was lower in females. Mean (SD) FBLoS was 98.1 (48.9) Newtons (N) in healthy subjects, 70.5 (39.8) N in PD patients H–Y stages I-II, and 37.7 (18.9) N in PD patients H–Y stage III. Compared to healthy subjects and when adjusted for age and gender, PD patients H–Y stages I-II exhibited the following: (a) a reduced FBLoS; (b) larger CoP displacements and higher velocities for the same applied force; and (c) combined ankle and hip strategies elicited by less intense pull forces. All of these abnormalities were more pronounced in H–Y stage III PD patients compared to H–Y stages I-II PD patients. In conclusion, patients in the early stages of PD already exhibit a degree of postural instability due to inefficient postural adjustments, and they can more easily be destabilized by small perturbations than healthy subjects. This balance impairment becomes more pronounced in more advanced PD. In the pull test, pull force to step back should be a variable to consider when testing balance in clinical practice.

First trial and StartReact effects induced by balance perturbations to upright stance

2013 ◽  
Vol 110 (9) ◽  
pp. 2236-2245 ◽  
Author(s):  
A. D. Campbell ◽  
J. W. Squair ◽  
R. Chua ◽  
J. T. Inglis ◽  
M. G. Carpenter
Keyword(s):  
Startle Response ◽  
Support Surface ◽  
Wrist Movement ◽  
Repeated Presentation ◽  
Trial Effect ◽  
Acoustic Stimuli ◽  
Postural Responses ◽  
Startreact Effect ◽  
Startling Stimulus ◽  
Repeated Test

Postural responses (PR) to a balance perturbation differ between the first and subsequent perturbations. One explanation for this first trial effect is that perturbations act as startling stimuli that initiate a generalized startle response (GSR) as well as the PR. Startling stimuli, such as startling acoustic stimuli (SAS), are known to elicit GSRs, as well as a StartReact effect, in which prepared movements are initiated earlier by a startling stimulus. In this study, a StartReact effect paradigm was used to determine if balance perturbations can also act as startle stimuli. Subjects completed two blocks of simple reaction time trials involving wrist extension to a visual imperative stimulus (IS). Each block included 15 CONTROL trials that involved a warning cue and subsequent IS, followed by 10 repeated TEST trials, where either a SAS (TESTSAS) or a toes-up support-surface rotation (TESTPERT) was presented coincident with the IS. StartReact effects were observed during the first trial in both TESTSAS and TESTPERT conditions as evidenced by significantly earlier wrist movement and muscle onsets compared with CONTROL. Likewise, StartReact effects were observed in all repeated TESTSAS and TESTPERT trials. In contrast, GSRs in sternocleidomastoid and PRs were large in the first trial, but significantly attenuated over repeated presentation of the TESTPERT trials. Results suggest that balance perturbations can act as startling stimuli. Thus first trial effects are likely PRs which are superimposed with a GSR that is initially large, but habituates over time with repeated exposure to the startling influence of the balance perturbation.

Interaction between acoustic startle and habituated neck postural responses in seated subjects

2007 ◽  
Vol 102 (4) ◽  
pp. 1574-1586 ◽  
Author(s):  
Jean-Sébastien Blouin ◽  
Gunter P. Siegmund ◽  
J. Timothy Inglis
Keyword(s):  
Startle Response ◽  
Acoustic Startle ◽  
Acoustic Startle Response ◽  
Neck Muscles ◽  
Whole Body ◽  
Neck Muscle ◽  
Postural Response ◽  
Root Mean Square Amplitude ◽  
Postural Responses ◽  
Spatial Changes

Postural and startle responses rapidly habituate with repeated exposures to the same stimulus, and the first exposure to a seated forward acceleration elicits a startle response in the neck muscles. Our goal was to examine how the acoustic startle response is integrated with the habituated neck postural response elicited by forward accelerations of seated subjects. In experiment 1, 14 subjects underwent 11 sequential forward accelerations followed by 5 additional sled accelerations combined with a startling tone (124-dB sound pressure level) initiated 18 ms after sled acceleration onset. During the acceleration-only trials, changes consistent with habituation occurred in the root-mean-square amplitude of the neck muscles and in the peak amplitude of five head and torso kinematic variables. The subsequent addition of the startling tone restored the amplitude of the neck muscles and four of the five kinematic variables but shortened onset of muscle activity by 9–12 ms. These shortened onset times were further explored in experiment 2, wherein 16 subjects underwent 11 acceleration-only trials followed by 15 combined acceleration-tone trials with interstimulus delays of 0, 13, 18, 23, and 28 ms. Onset times shortened further for the 0- and 13-ms delays but did not lengthen for the 23- and 28-ms delays. These temporal and spatial changes in EMG can be explained by a summation of the excitatory drive converging at or before the neck muscle motoneurons. The present observations suggest that habituation to repeated sled accelerations involves extinguishing the startle response and tuning the postural response to the whole body disturbance.

Influence of instruction, prediction, and afferent sensory information on the postural organization of step initiation

1996 ◽  
Vol 75 (4) ◽  
pp. 1619-1628 ◽  
Author(s):  
A. Burleigh ◽  
F. Horak
Keyword(s):  
Anticipatory Postural Adjustments ◽  
Postural Response ◽  
Postural Adjustments ◽  
Automatic Postural Response ◽  
Step Initiation ◽  
Postural Responses ◽  
Automatic Response ◽  
Perturbation Velocity ◽  
Velocity Information ◽  
Automatic Postural Responses

1. Our previous study showed that two distinct postural modifications occurred when subjects were instructed to step, rather than maintain stance, in response to a backward surface translation: 1) the automatic postural responses to the surfaces perturbation were reduced in magnitude and 2) the anticipatory postural adjustments promoting foot-off were shortened in duration. This study investigates the extent to which task instruction, prediction of perturbation velocity, and afferent sensory information related to perturbation velocity are responsible for these postural modification. 2. Eleven human subjects were instructed in advance, to either maintain stance or step forward in response to a backward surface translation. Four different velocities of translation were used to perturb equilibrium. To assess the influence of predicted versus actual velocity information, the surface translations were presented in both a blocked order of increasing perturbation velocity (predictable) and a random order (unpredictable). Lower-extremity electromyographs (EMGs), ground reaction forces, and movement kinematics were quantified for both the automatic postural responses to perturbation and the anticipatory postural adjustments for step initiation. 3. The instruction to step was not solely responsible for the suppression of the automatic postural response. Prediction of perturbation velocity was required for significant suppression of the early automatic postural response when subjects stepped in response to the perturbation. When compared with the stance condition, the magnitude of the initial 50 ms of the automatic response in bilateral soleus and the left limb gastrocnemius (initial stance limb) was significantly reduced only when the perturbation velocities were presented in a blocked order. The magnitude of the automatic response was not reduced in the gastrocnemius of the right limb, which was always the initial swing limb and recruited for heel-off in the step conditions. This asymmetrical reduction of the gastrocnemius suggests that modification of the response was specific to the instruction, rather than a general decrease in the extensor muscle excitability. 4. The suppression of the early automatic postural response involved a change in the bias of the response. Despite the reduced magnitude during the predictable velocity step condition, the slope (i.e., gain) of the response with increasing velocities was not different from that of the stance condition. Thus the excitability of the automatic response was reduced by a relatively constant amount for each velocity when the perturbation velocity was predictable. 5. In contrast to the importance of velocity prediction for modification of the automatic postural response, actual velocity information was used for modification of the anticipatory postural adjustments when step was initiated in response to the surface perturbation. Regardless of whether the perturbation velocities were presented in a blocked or random order, the anticipatory postural adjustments were rapidly initiated and the duration of the postural adjustments for step initiation was shortened as the velocity of perturbation increased. 6. We conclude that the CNS uses prediction of perturbation velocity to modify the excitability of early automatic postural responses when the postural goal changes. In contrast, actual afferent velocity information can be used to modify the duration of the anticipatory postural adjustments for a voluntary step in response to perturbation. Thus the CNS utilizes feed-forward prediction to modify peripherally triggered postural responses, and utilizes immediate afferent information to modify the centrally initiated postural adjustments associated with voluntary movement.

scholarly journals Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study (Preprint)

2018 ◽  
Author(s):  
Leia C Shum ◽  
Bulmaro A Valdés ◽  
HF Machiel Van der Loos
Keyword(s):  
Upper Limb ◽  
Relative Position ◽  
Motion Tracking ◽  
Tracking System ◽  
Motor Rehabilitation ◽  
Step Size ◽  
Position Accuracy ◽  
Upper Limb Movements ◽  
Motion Tracking System ◽  
Play Space

BACKGROUND As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications. OBJECTIVE This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space. METHODS Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units. RESULTS It was found that the maximum position accuracy error of the system was 3.5 ± 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 ± 9.9% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system. CONCLUSIONS The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy.

An Instrumented Pull Test to Characterize Postural Responses

10.3791/59309 ◽  
2019 ◽  
Author(s):  
Joy Tan ◽  
Wesley Thevathasan ◽  
Jennifer McGinley ◽  
Peter Brown ◽  
Thushara Perera
Keyword(s):  
Pull Test ◽  
Postural Responses

Changes in a postural strategy with inter-paw distance

1994 ◽  
Vol 71 (3) ◽  
pp. 931-940 ◽  
Author(s):  
J. M. Macpherson
Keyword(s):  
Horizontal Plane ◽  
Vertebral Column ◽  
Center Of Mass ◽  
The Other ◽  
Support Surface ◽  
Quiet Stance ◽  
Postural Response ◽  
Isotropic Distribution ◽  
Platform Translation ◽  
The One

1. The purpose of this study was to examine the effect of changing initial stance conditions on the postural response of the cat to horizontal plane translations of the support surface. Cats were trained to stand, unrestrained, on a moveable force platform. The platform was translated linearly in each of 16 directions in the horizontal plane, with a ramp-and-hold displacement. The animal's response was quantified in terms of the forces exerted at the ground. The trajectory of the center of mass (CoM) was computed from the forces. 2. Stance length was varied along the longitudinal (sagittal) axis by adjusting the distance between the forepaw and hindpaw force plates. Translation perturbations of the platform were recorded at stance distances varying from 66 to 110% of the preferred stance distance. 3. Changing stance distance had a significant effect on the amplitude and direction of the active forces exerted by the cat both during quiet stance and during the response to platform translation. At long stance distances, each limb exerted a force outward, along the diagonals during quiet stance. The response to translation was characterized by an invariance in the direction of force exerted against the ground, a strategy that was described previously. At short stance distances, quiet stance forces were more laterally directed. The force constraint strategy was usually not observed for the response to translation. Nevertheless, the cats were equally effective at all stance distances in restoring the position of the center of mass after translation of the support surface. 4. There was no discrete boundary between the presence and absence of the force constraint, suggesting that the strategy for exerting forces against the support surface is characterized by a continuum of response, from a bimodal, or anisotropic distribution of force vectors on the one extreme, to a uniform, or isotropic distribution on the other. Arguments are developed to suggest that the force constraint strategy may be useful in stabilizing the vertebral column during the response to platform translation, to allow linear translation of the CoM rather than bending of the trunk.

Electrical and Mechanical Performance of Quilt Packaging with Solder Paste by Pin Transfer

2012 ◽  
Vol 2012 (1) ◽  
pp. 000441-000446
Author(s):  
Quanling Zheng ◽  
M. Ashraf Khan ◽  
Alfred M. Kriman ◽  
Gary H. Bernstein
Keyword(s):  
Integrated Circuit ◽  
Mechanical Performance ◽  
Test System ◽  
The Self ◽  
Solder Paste ◽  
Mechanical Reliability ◽  
Pull Force ◽  
Pull Test ◽  
2D System ◽  
Quilt Packaging

Electrical and mechanical performance of Quilt Packaging (QP), a 2D system-in-package chip-to-chip interconnection, is presented. QP employs contacts at the edges of integrated circuit dies along their vertical surfaces. Based on 3D HFSS simulations, the self-inductance of QP can be less than 0.01 nH, and the self-capacitance can be less than 0.034 pF due to the shortness of the interconnection path. QP interconnection using solder paste with pin transfer is presented, and mechanical reliability is evaluated. A new pull test system specifically designed for QP is presented. The pull force that causes failure in a set of edge interconnects totaling 3 mm width of nodules is about 658 gram-force for Sn63Pb37 and 953 gram-force for SAC305.

The Pontomedullary Reticular Formation Contributes to the Compensatory Postural Responses Observed Following Removal of the Support Surface in the Standing Cat

2009 ◽  
Vol 101 (3) ◽  
pp. 1334-1350 ◽  
Author(s):  
Paul J. Stapley ◽  
Trevor Drew
Keyword(s):  
Reticular Formation ◽  
Discharge Frequency ◽  
Secondary Response ◽  
Support Surface ◽  
Postural Response ◽  
Reticulospinal Neurons ◽  
Vertical Pressure ◽  
Postural Responses ◽  
Reticular Neurons ◽  
Increased Activity

This study was designed to determine the contribution of reticular neurons in the pontomedullary reticular formation (PMRF) to the postural responses produced to compensate for an unexpected perturbation. We recorded the activity of 48 neurons in the PMRF, including 41 reticulospinal neurons, to removal of the support surface under each of the four limbs in four cats. The perturbations produced robust postural responses that were divided into three periods: an initial postural response (P1) that displaced the center of vertical pressure over the two diagonal supporting limbs; a secondary response (P2) during which the cat restored a tripedal support pattern; and a prolonged tertiary response (P3) that maintained a stable posture over all three supporting limbs. Most (44/48) reticular neurons showed modified activity to perturbation of at least one limb and a majority (39/48) showed changes in activity to perturbations of more than one limb. A few (7/48) discharged to perturbations of all four limbs. Discharge frequency in neurons showing increased activity during P1 was relatively high (>100 Hz in 57% of the neurons responding to perturbations of either the left or right forelimbs, lFl and rFL) and of short latency (17 ms for the lFL and 14 ms for the rFL). Discharge activity in most neurons was sustained throughout P2 and P3 but at a reduced level. These data show that neurons in the PMRF discharge strongly in response to unexpected perturbations and in a manner consistent with a contribution to the compensatory responses that restore equilibrium.

Effect of galvanic vestibular stimulation on human postural responses during support surface translations

1995 ◽  
Vol 73 (2) ◽  
pp. 896-901 ◽  
Author(s):  
J. T. Inglis ◽  
C. L. Shupert ◽  
F. Hlavacka ◽  
F. B. Horak
Keyword(s):  
Vestibular System ◽  
Equilibrium Position ◽  
Critical Role ◽  
Vestibular Stimulation ◽  
Galvanic Vestibular Stimulation ◽  
Support Surface ◽  
Quiet Stance ◽  
Galvanic Current ◽  
Postural Responses ◽  
Platform Translation

1. We investigated the role of the vestibular system in postural control by combining galvanic vestibular stimulation (0.2-0.5 mA) with platform translations in standing subjects. Vestibular stimulation delivered 500 ms before and continuously during the platform translation produced little change in the earliest center of pressure (COP) and center of mass (COM) movements in response to platform translations, but resulted in large changes during the execution of the postural movement and in the final equilibrium position. 2. Vestibular stimulation produced anterior or posterior shifts in the position of COP and COM, depending on the polarity of the galvanic current. These shifts were larger during platform translations than during quiet stance. The peak of these shifts in COP and COM occurred at 1.5-2.5 s after the onset of platform translation, and increased in magnitude with increasing platform velocity. The final equilibrium positions of COP and COM were also shifted, but these shifts were smaller and not dependent on platform velocity. 3. These results imply that a tonic step of galvanic current to the vestibular system can change the final equilibrium position for an automatic postural response. Furthermore, these results indicate that the vestibular system may play a larger role in interpreting sensory reafference during postural movements, and especially during fast postural movements, than in controlling quiet stance. Finally, these results indicate that the vestibular system does not play a critical role in triggering the earliest postural responses, but it may be critical in establishing an internal reference for verticality.

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