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J Neurophysiol (September 26, 2007). doi:10.1152/jn.01303.2006
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Submitted on December 13, 2006
Accepted on September 21, 2007

Incorporating voluntary knee flexion into non-anticipatory balance corrections

Lars Bernard Oude Nijhuis1, Bastiaan R. Bloem1, Mark G. Carpenter2, and John HJ Allum3*

1 Department of Neurology (935), Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
2 School of human kinetics, University of British Columbia, Vancouver, Canada
3 ORL Clinic, University of Basel, Basel, Switzerland

* To whom correspondence should be addressed. E-mail: jallum{at}uhbs.ch.

Knee movements play a critical role in most balance corrections. Loss of knee flexibility may cause postural instability. Conversely, trained voluntary knee flexions executed during balance corrections might help to overcome balance deficits. We examined whether bilateral knee flexion could be added to automatic balance corrections. We investigated how this could be achieved and whether it improved or worsened balance control. Twenty-four healthy subjects participated in three different test conditions, in which they had to flex their knees following an auditory cue (VOLUNTARY condition), had to restore their balance in response to multidirectional rotations of a support-surface (REACTIVE condition), or the combination of these two (COMBINED condition). A new variable set (PREDICTED), calculated as the mathematical sum of VOLUNTARY and REACTIVE, was compared to the COMBINED variable set. COMBINED responses following forward rotations were close to PREDICTED, or greater, suggesting adequate integration of knee flexion into the automatic balance reactions. For backward rotations, the COMBINED condition resulted in several near-falls, and this was associated with smaller knee flexion and smaller EMG responses. Subjects compensated by using greater trunk flexion and arm movements. Activity in several muscles displayed earlier onsets for the COMBINED condition following backward rotations. We conclude that healthy adults can incorporate voluntary knee flexion into their automatic balance corrections, and that this depends upon the direction of the rotation. These findings highlight the flexibility of the human balance repertoire, and underscore both the advantages and limitations of using trained voluntary movements to aid balance corrections in man.




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L. B. Oude Nijhuis, J. H. J. Allum, G. F. Borm, F. Honegger, S. Overeem, and B. R. Bloem
Directional Sensitivity of "First Trial" Reactions in Human Balance Control
J Neurophysiol, June 1, 2009; 101(6): 2802 - 2814.
[Abstract] [Full Text] [PDF]




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