Measurement of postural sway: posturographic

instrumentation

6
6
-
-
components force plattform
components force plattform

3
3
-
-
components force platforms
components force platforms

Pressure platforms
Pressure platforms
Measurement of postural sway: the dynamometric or
force platform
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z
y
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x
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z
y
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y
x
f
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M
M
M
M
F
F
F
Force sensors
Distributed load on the platform

Stress on the support elements (3 or 4) force sensors

Resultant stress: force (3 components) & moment (3 component)

or
Resultant force vector & Center of pressure (COP)
Force platform: piezoelectric vs estensimetric (strain
gauges)
Force sensors
Force sensors
Piezoelectric: strain-modulated capacitors; higher bandwidth and sensitivity,
no DC component; charge amplifiers; better for gait analysis
Strain gauges: strain-modulated resistors; lower bandwidth and sensitivity; DC
component; Wheatstone bridge + operational amplifier; better for posturography
Force sensors
Mono-component
Multi-component (usually 3)
Leading manufacturers: Kistler, AMTI
Force platform: 6 components
Force sensors
Multi-component force sensors
linearity between force-sensor readings and the 6 components of the resultant
stress
the proportionality matrix [M] is estimated by means of a calibration procedure
in the factory, in which stress and sensor readings are both known and is provided
by the manufacturer as an integral part of the instrument
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F
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+
=

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z
x y
COP
z
y x
COP
F
M hF
y
F
M hF
x
Leading manufacturers: Kistler, AMTI, Bertec
Force platform: 3 components
Force sensors
In posturography (not in gait analysis) F
x
, F
y
, M
z
are very small in comparison
with the other components and thus can be neglected
Mono-component force sensors (strain-guage load cells)
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3
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y
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F

=
z
x
COP
z
y
COP
F
M
y
F
M
x
Local manufacturer: RGM
Measurement of postural sway: pressure mats
Elastic Elastic
material material
F F
Matrix of force sensors that are scanned during acquisition
of a force image
Reistive sensors or capacitive sensors
Problems:
creep & hysteresis
limited accuracy and bandwidth
Leading manufacturer: Novel
Measurement of postural sway: pressure insoles
Leading manufacturer: Tekscan
Matrix of force sensors that are scanned during acquisition of a force image
Reistive sensors or capacitive sensors
Problems:
creep & hysteresis
limited accuracy and bandwidth
Measurement of postural sway
Relevant variables:
1. Centre of mass (COM)
2. Centre of Pressure (COP)
3. Force of gravity (applied to the COM)
4. Ground reaction (applied to the COP)
5. Ankle torque
Posturographic signals: Statokinesigrams &
posturograms (different visualizations of the COP)
COP vs COM
COM & COP
are similar
Strongly
correlated but
different
frequency
bandwidths:
0.5 Hz vs 5 Hz
COM [mm]
COP vs COM
The COP signal is measured by the force
platform.
The COM signal is evaluated indirectly in one of
two methods:
1. Acquisition of full-body model by means
of stereophotogrammetry + usage of an
anthropometric model + application of the
basic definition of COM
2. Exploiting the dynamic equation of sway
and transforming it into a low-pass filter
( ) COP COM
h
g
dt
COM d
=
2
2
( ) ) ( ) ( ) ( ) (
2

COP COM COM
F F
h
g
F j =
) (
/
/
) (
2

COP COM
F
h g
h g
F
+
=
COM [mm]
Phenomenological analysis: global parametrs
Space-time domain
Frequency
domain
Phenomenological analysis: Diffusion plot
Collins and De Luca 1993
Sway is interpreted as a
fractional Brownian motion
In a pure Brownian motion the
variance of X, Y, L grows
linearly with t.
In a fractional Brownian motion
there is a critical time
Parameters: critical time and
critical variances
1. Clusters of samples (slow phases)
2. Quick shifts from one cluster to another
Beyond the apparent randomness of the
posturogram there is a regular structure,
characterized by:
Definition of the Sway-Density Plot:
For each time instant, the number of consecutive
samples of the COP which fall inside a circle of
given radius (R=2.5 mm), multiplied by the
sampling time.
Baratto L, Morasso P, Re C, Spada G (2002) A
new look at posturographic analysis in the clinical
context: sway-density vs. other parameterization
techniques. Motor Control, 6, 248-273
Phenomenological analysis: Sway density plot
Sway Density parameters
Sampling
frequency:
100 Hz
Raw plot
Low-pass
filtered
plot (2.5 Hz)
MT: mean time between peaks
MP: mean value of the peaks
MD: mean distance between the peaks
Sway density plots
Most discriminant posturographic paremteres
NOR: nomali
OPR: osteoporotici
PAR: parkinsoniani
Measurement features
General characteristics of the measurement systems:
Linearity/hysteresis
Resolution (N, Nm, mm)
Frequency bandwith (Hz)
Clinically relevant features in posturography:
Spatial resolution of the COP: 0.1 - 0.2 mm
Frequency band: it must include 0 Hz and exceed 5 Hz
Which is the influence of the heart beat on the
posturographic traces?
Method of the synchronized averaging (typically
used in Evoked Potentials), using as trigger the
peak P of the QRS complex in the ECG
Conforto et al 2001
Cardiac activity force
Consider the AP component of the cardiac activity force:
the variance of the signal is about F=0.15 N.
Supposing that the mass of the subject is m=80 kg, the
height of the come is h=0.85 m, we can estimate the COP
shift u:
=Fh=mg u u=0.16 mm
AP
The need of calibration: force platforms are
precision instruments
Two approaches:
static point to point loading
dynamic loading
Dynamic calibration device
Recalibration
Before
calibration
After
calibration
Calculating the degree of
isotropy and estimating a
calibration matrix
Dynamic equations of sway
Free body diagram
( ) u y
h
g
y
e
=
& &
Morasso & Sanguineti, J. Neurophysiol. 2002
Foot
0 = mgu
m

Upper body

& &
I
g m
= +

=
=
= =
h y
mh I
mgh mgy
g
/
2
& &
& &

h h
e
=
Instability of the system
( ) u y
h
g
y
e
=
& &
U(s)
e
e
h g s
h g
/
/
2

Controller
Y(s)
The COP is the control variable
The COM is the controlled variable
The plant has one pole in the right plane:
e
h
g
s =

& &
I
g m
= +
Instability of the system
I
I
mgh
m
/ =
& &

m
(s)
I mgh s
I
/
/ 1
2

Controller
(s)
The ankle torque is the control variable
The sway angle is the controlled variable
The plant has one pole in the right plane:
I
mgh
s =

& &
I
g m
= +
act a m
K + =
Destabilizing torque:
Control torque:
The role of intrinsic ankle stiffness
mgh K
c
=
mgh
g
=
Critical value of ankle
stiffness

& &
I
g m
= +
) (
a act
K mgh I =
& &

<
>


c a
c a
K K
K K
The system is intrinsically asymptotically stable
The system is unstable and must be stabilized by
active control
Estimation of ankle stiffness
Casadio et al, Gait & Posture 2005
Pattern of recovery from
unpredicted disturbances:
Backward pull due to muscle
stiffness (GM+GL)
Initiation of the backward fall
Stabilization of the fall due to
anticipatory activation of the
TA
Direct measurement of ankle stiffness

a a a a
K B I t u mg + + = =
& & &
) (
Direct measurement of ankle stiffness
c a
K K % 65
Stiffness control, by alone, is insufficient to stabilize upright standing
c a
K K % 90
deg 05 . 0 =
Direct measurement of ankle stiffness
Casadio, Morasso & Sanguineti, Gait and Posture, 2004
deg 1 =
2005
Stabilization by linear continuous closed loop control
Phase portrait
Flowlines of the
inverted pendulum
Phase portrait
Phase portrait
Scalar product
between the flowlines
of the inverted
pendulum and the
swayline:
cos=1: falling
Aaverage duration of
the falling phases:
0.40.38 s
The control is
intermittent
Decomposition of the ankle torque
) ( ) ( t u mg t
a
=
Jacono, Casadio, Morasso, Sanguineti. Motor Control,
2004
tonic component (67%)
anticipatory phasic component (13%)
stiffness component (20%)
STRATEGIES OF POSTURAL STABILIZATION:
STRATEGIES OF POSTURAL STABILIZATION:
COP strategy
COP strategy
Ankle Strategy or COP Strategy:
direct quick - anticipatory mechanism
Gagey et al 2002
( ) u y
h
g
y
e
=
& &
STRATEGIES OF POSTURAL STABILIZATION:
STRATEGIES OF POSTURAL STABILIZATION:
COM strategy
COM strategy
Hip Strategy or COM Strategy:
Indirect slow - feedback mechanism
Gagey et al 2002
( ) u y
h
g
y
e
=
& &