Objective, quantitative postural data is limited for individuals who are non-ambulatory, especially for those who have not yet developed trunk control for sitting. There are no gold standard measurements to monitor the emergence of upright trunk control. Quantification of intermediate levels of postural control is critically needed to improve research and intervention for these individuals. Accelerometers and video were used to record postural alignment and stability for eight children with severe cerebral palsy aged 2 to 13 years, under two conditions, seated on a bench with only pelvic support and with additional thoracic support. This study developed an algorithm to classify vertical alignment and states of upright control; Stable, Wobble, Collapse, Rise and Fall from accelerometer data. Next, a Markov chain model was created to calculate a normative score for postural state and transition for each participant with each level of support. This tool allowed quantification of behaviors previously not captured in adult-based postural sway measures. Histogram and video recordings were used to confirm the output of the algorithm. Together, this tool revealed that providing external support allowed all participants: (1) to increase their time spent in the Stable state, and (2) to reduce the frequency of transitions between states. Furthermore, all participants except one showed improved state and transition scores when given external support.
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Postural mechanisms in moderate-to-severe cerebral palsy
People with moderate-to-severe cerebral palsy (CP) have the greatest need for postural control research yet are usually excluded from research due to deficits in sitting ability. We use a support system that allows us to quantify and model postural mechanisms in nonambulatory children with CP. A continuous external bench tilt stimulus was used to evoke trunk postural responses in seven sitting children with CP (ages 2.5 to 13 yr) in several test sessions. Eight healthy adults were also included. Postural sway was analyzed with root mean square (RMS) sway and RMS sway velocity, along with frequency response functions (FRF, gain and phase) and coherence functions across two different stimulus amplitudes. A feedback model (including sensorimotor noise, passive, reflexive, and sensory integration mechanisms) was developed to hypothesize how postural control mechanisms are organized and function. Experimental results showed large RMS sway, FRF gains, and variability compared with adults. Modeling suggested that many subjects with CP adopted “simple” control with major contributions from a passive and reflexive mechanism and only a small contribution from active sensory integration. In contrast, mature trunk postural control includes major contributions from sensory integration and sensory reweighting. Relative to their body size, subjects with CP showed significantly lower damping, three to five times larger corrective torque, and much higher sensorimotor noise compared with the healthy mature system. Results are the first characterization of trunk postural responses and the first attempt at system identification in moderate-to-severe CP, an important step toward developing and evaluating more targeted interventions. NEW & NOTEWORTHY Cerebral palsy (CP) is the most common cause of motor disability in children. People with moderate-to-severe CP are typically nonambulatory and have major impairments in trunk postural control. We present the first systems identification study to investigate postural responses to external stimulus in this population and hypothesize at how the atypical postural control system functions with use of a feedback model. People with moderate-to-severe CP may use a simple control system with significant sensorimotor noise.
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- Award ID(s):
- 2015660
- NSF-PAR ID:
- 10233231
- Date Published:
- Journal Name:
- Journal of Neurophysiology
- Volume:
- 125
- Issue:
- 5
- ISSN:
- 0022-3077
- Page Range / eLocation ID:
- 1698 to 1719
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Capers, Miriam (Ed.)Supraspinal signals play a significant role in compensatory responses to postural perturbations after spinal cord injury (SCI). SCI disrupts descending motor control signals as well as ascending somatosensory information to and from below the lesion. In intact animals, While cortical signals are not necessary for basic postural tasks, but neurons in the motor cortex have been shown to respond to periodic postural perturbations in intact animals. However, the role of the cortex in postural control after spinal cord injury in response to unexpected postural perturbations has not been studied. To better understand how spinal lesions impact cortical encoding of information about unexpected postural perturbations, the activity of single neurons in the rat hindlimb sensorimotor cortex (HLSMC) were recorded during unexpected tilts before and after a complete midthoracic spinal transection. In a subset of animals, limb ground reaction forces were collected as well. Results show that responses in the HLSMC were modulated with changes in tilt severity (i.e. tilt velocity). As initial velocity of the tilt increased, more information was conveyed by the HLSMC neurons about the perturbation due to increases in both the number of recruited neurons and the magnitude of their response. After SCI hindlimb ground reaction forces were both attenuated and delayed, and the neural responses were delayed and less likely to respond to slower tilts. This resulted in a moderate decrease inan attenuation of the information conveyed by cortical neurons about the tilts, requiring more cells to convey the same amount of information as before the transection. Given that reorganization of the hindlimb sensorimotor cortex in response to therapy after complete mid-thoracic SCI is necessary for behavioral recovery, this sustained encoding of information after SCI could be a substrate for the reorganization that uses sensory information from above the lesion to control trunk muscles that permit weight-supported stepping and postural control.more » « less
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null (Ed.)Abstract Sensorimotor integration in the trunk system is poorly understood despite its importance for functional recovery after neurological injury. To address this, a series of mapping studies were performed in the rat. First, the receptive fields (RFs) of cells recorded from thoracic dorsal root ganglia were identified. Second, the RFs of cells recorded from trunk primary sensory cortex (S1) were used to assess the extent and internal organization of trunk S1. Finally, the trunk motor cortex (M1) was mapped using intracortical microstimulation to assess coactivation of trunk muscles with hindlimb and forelimb muscles, and integration with S1. Projections from trunk S1 to trunk M1 were not anatomically organized, with relatively weak sensorimotor integration between trunk S1 and M1 compared to extensive integration between hindlimb S1/M1 and trunk M1. Assessment of response latency and anatomical tracing suggest that trunk M1 is abundantly guided by hindlimb somatosensory information that is derived primarily from the thalamus. Finally, neural recordings from awake animals during unexpected postural perturbations support sensorimotor integration between hindlimb S1 and trunk M1, providing insight into the role of the trunk system in postural control that is useful when studying recovery after injury.more » « less
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1152/jn.00549.2020
