To date, no systematic research investigating cortical correlates of performance changes in dual tasking has been reported in the elderly population. Thus, we monitored whole-scalp cortical activations (EEG) during both single task and posture-cognition dual tasking with the main goal of understanding cortical activity modulations underlying age-related differences on posture-cognition dual tasking conditions. Postural and cognitive data analyses showed that elderly people had decreased cognitive performance even during challenging single cognitive tasks. Working memory impairments in the elderly group can be observed when a challenging cognitive task is performed in any postural condition, while postural control performance differences only became significant during challenging dual task conditions. Behavioral performance results, in general, indicate that elderly subjects may adopt a non-automated conscious control strategy and prioritize postural performance over cognitive performance to maintain upright stance only when the cognitive load is low. EEG analyses showed increased delta, theta and gamma oscillations, primarily over frontal, central-frontal, central and central-parietal cortices during dual tasking conditions. We found that delta oscillations were more responsive to challenging postural conditions presumably related to cortical representations of changing sensory conditions in postural tasks. Theta rhythms, on the other hand, were more responsive to cognitive task difficulty in both groups, with more pronounced increases in younger subjects which may underlie neural correlates of high-level cognitive computations including encoding and retrieval. Gamma oscillations also increased in the elderly primarily over central and central-parietal cortices during challenging postural tasks, indicating increased allocation of attentional sources to postural tasks.
It has been shown that torso-based vibrotactile feedback significantly reduces postural sway in balance-compromised adults during quiet standing and in response to perturbations. This study aimed to determine whether vibrotactile stimulations applied to different torso locations induced directional postural responses and whether torso cutaneous information contributes to body representation. Eleven healthy young adults equipped with an inertial measurement unit (IMU) placed on the torso were asked to maintain an upright posture with closed eyes. Six vibrators (tactors) were placed on the torso in contact with the skin over the left and right external oblique, internal oblique, and erector spinae muscles at the L4/L5 level. Each tactor was randomly activated four times per location at a frequency of 250 Hz for a period of 5 s. The IMU results indicated that vibration applied individually over the internal oblique and erector spinae muscles induced a postural shift of about one degree oriented in the direction of the stimulation, while simultaneous activation of all tactors and activation of tactors over external oblique muscles produced insignificant postural effects. The root mean square of the sway signal was significantly higher during vibration than before or after. However, the center of pressure displacement, measured by a force plate, was uninfluenced by any vibration. These results suggest a multi-joint postural response including a torso inclination associated with vibration-induced changes in cutaneous information. The directional aspect of vibration-induced postural shifts suggests that cutaneous information from the stimulated areas contributes to proprioception and upper body spatial representation.
Motor responses to unexpected external perturbations require the adjustment of the motor commands driving the ongoing activity. Strategies can be learned with practice to compensate for these unpredictable perturbations (e.g., externally induced slips and trips). It has been hypothesized that response improvements reflect the adaptation of motor commands through updates of an internal model. This hypothesis may be nuanced when a pre-existing motor response could be used. In that case, since a relatively adequate response is known, only the timing of the command needs to be determined. If so, then it could be inferred that the timing of movement initiation and the specific sequence of motor commands can be dissociated. Previously, we quantified the benefits of cuing vs. learning on recovery motor responses resulting from a trip induced by the abrupt stop of one side of a split belt treadmill. Trip occurrence was randomized within a series of strides. Two groups of young adults participated to two distinct experiments (learning, cuing). In the learning experiment, trip recovery improved progressively from the 4th to the 8th trial to reach an "adapted response". In the cuing experiment, trip recovery was immediate (from 1st trial). Expanding from these results, the aim of the present work was to differentiate the processes underlying the generation of motor compensation strategies in response to an external perturbation under time uncertainty. A supplementary analysis revealed that "cued" responses were kinematically similar to the "adapted response" and remained invariant regardless of cue lead time (250, 500 ms before trip) and application location of the cue (arm, trunk, lower leg). It is posited that all responses (cued and non-cued) are the expression of a pre-existing motor program derived from life experiences. Here, the cue significantly reduces time uncertainty and adaptation consists primarily in resolving time uncertainty based on the trial-by-trial learning of the stochastic property of trip occurrence in order to reduce the response delay. Hence, response time delay and motor program parameters appear to stem from two distinct processes.
BackgroundEarlier versions of biofeedback systems for balance-related applications were intended primarily to provide “alarm” signals about body tilt rather than to guide rehabilitation exercise motion. Additionally, there have been few attempts to evaluate guidance modalities for balance rehabilitation exercises. The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings.MethodsA motion guidance system providing visual biofeedback, vibrotactile biofeedback, or both, was used during weight-shifting exercises. Eleven people with idiopathic Parkinson’s disease (PD) and nine healthy elderly people participated. Each participant wore a six-degree-of-freedom inertial measurement unit (IMU) located near the sacrum and four linear vibrating actuators (Tactors) attached to the skin over the front, back, and right and left sides of the abdomen. The IMU measured angular displacements and velocities of body tilt in anterior-posterior (A/P) and medial-lateral (M/L) directions. Participants were instructed to follow a slow moving target by shifting their weight in either the A/P or M/L direction up to 90 % of their limits of stability (LOS). Real-time position error was provided to participants in one of three sensory modalities: visual, vibrotactile, or both. Participants performed 5 trials for each biofeedback modality and movement direction (A/P and M/L) for a total of 30 trials in a random order. To characterize performance, position error was defined as the average absolute difference between the target and participant movements in degrees.ResultsSimultaneous delivery of visual and vibrotactile biofeedback resulted in significantly lower position error compared to either visual or vibrotactile biofeedback alone regardless of the movement direction for both participant cohorts. The pairwise comparisons were not significantly different between visual and vibrotactile biofeedback.ConclusionThe study is the first attempt to assess the effects of guidance modalities on common balance rehabilitation exercises in people with PD and healthy elderly people. The results suggest that combined visual and vibrotactile biofeedback can improve volitional responses during postural tracking tasks.Index Terms – sensory augmentation, weight-shifting balance exercise, guidance modality, vibrotactile biofeedback, visual biofeedback, Parkinson’s disease.
BackgroundTorso-based vibrotactile feedback may significantly reduce postural sway in balance-compromised adults during quiet standing or in response to perturbations. However, natural non-volitional postural responses to vibrotactile stimulation applied to the torso remain unknown.MethodsThe primary goal of this study was to determine, for two types of actuators (tactors) and in the absence of instruction, whether vibrotactile stimulation induces a directional postural shift as a function of stimulation location. Eleven healthy young adults (20 – 29 years old) were asked to maintain an upright erect posture with feet hip-width apart and eyes closed. Two types of tactors, Tactaid and C2, which differ in design and stimulation strength, were placed on the skin over the right and left external oblique, internal oblique, and erector spinae muscles in a horizontal plane corresponding approximately to the L4/L5 level. Each tactor of the same type was activated twice randomly for each individual location and twice simultaneously for all locations at a frequency of 250 Hz for a period of 5 s.ResultsVibration applied over the internal oblique and erector spinae muscle locations induced a postural shift in the direction of the stimulation regardless of the tactor type. For the aforementioned four locations, the root-mean-square (RMS) and power spectral density (PSD) of the body sway in both the A/P and M/L directions were also significantly greater during the vibration than before or after, and were greater for the C2 tactors than for the Tactaid tactors. However, simultaneous activation of all tactors or those over the external oblique muscle locations did not produce significant postural responses regardless of the tactor type.ConclusionThe results suggest that the use of a torso-based vibrotactile sensory augmentation display should carefully consider the tactor type as well as the instruction of corrective movements. Attractive instructional cues (“move in the direction of the vibration”) are compatible with the observed non-volitional response to stimulation and may facilitate postural adjustments during vibrotactile biofeedback balance applications.
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