|Year : 2017 | Volume
| Issue : 2 | Page : 78-82
Coordination of body segments during turning in healthy adults: A review
Rufai Y Ahmad
Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
|Date of Web Publication||5-Oct-2017|
Rufai Y Ahmad
Department of Physiotherapy, Bayero University, Kano, P.M.B. 3011, Kano State
Source of Support: None, Conflict of Interest: None
Turning around to interact with the environment is a common activity of daily living. Coordination of body segments during turning is very important for the maintenance of upright posture. The aim of this review was to provide information about coordination of body segments during turning in health adults to serve as a yardstick for identifying turning problems in patients with neurological problems. Literature search was conducted through CINHAL, EMBASE, MEDLINE, and Google Scholar from inception to 2012 using the following search terms: coordination and turning, onset latency and turning, and peak velocity and turning. The present review has shown that turning to predictable targets results in a separate top to bottom sequence of onset of rotation of body segments, while turning to predictable targets results in a more simultaneous onset of rotation of the segments. On the contrary, the angle or direction a person turns to does not affect the sequence of rotation of body segments during turning. The peak velocity of the head was shown to be higher than that of the shoulder and pelvis when turning on-the-spot. The head was also shown to reach its peak velocity earlier than the shoulder and pelvis. However, the effect of the predictability of a target, turn angle, and turn direction on either the peak velocity or the time to reach the peak velocity has not been reported. The onset of rotation of body segments during turning while walking was shown to be in a top to bottom sequence. Alteration of the normal sequence of rotation of segments during turning could challenge the balance of an individual and may subsequently result into falls.
Keywords: Coordination, onset latency, peal velocity, turning
|How to cite this article:|
Ahmad RY. Coordination of body segments during turning in healthy adults: A review. Niger J Basic Clin Sci 2017;14:78-82
| Introduction|| |
Turning from one point to another to interact with the environment is a common activity of daily living. Eight to 50% of steps taken during activities of daily living involve turning., Coordination of body movement during turning is controlled by the interaction of sensory, motor, and cognitive processes. Sensory systems (visual, vestibular, and proprioceptive) provide information about the relationship of the body parts to each other and to objects in the environment. Integration of the sensory information by the cognitive system is essential for planning the movement strategy. The brain utilizes the processed information to issue commands for the activation of specific movement components which, when linked together in the appropriate spatial and temporal sequence, make up the desired task.
People with neurological conditions such as stroke and Parkinson's disease could present with impairments of the sensory, motor, or cognitive systems , and thus could present with movement incoordination. Indeed, people with neurological problems have been reported to have high incidence of falls while turning around.,,, It is not completely understood why they fall; however, there are suggestions that the relative movement of body segments during functional movements play a role in controlling the center of mass within the base of support., This means that impairment of the normal sequence of movement of body segments during turning may affect the balance of an individual and may explain why people with neurological problems often fall during turning.
The main aim of rehabilitation of people with neurological problems is to assess and manage the impairments to return the individual to the highest functional level. To achieve this, rehabilitation practitioners are faced with two questions:Firstly, what are the features of motor control processes in normal individuals? This is reflected in the statement of Carr and Shepherd  that “the unique contribution of physiotherapy to the rehabilitation of stroke lies potentially, in the training of motor control based on an understanding of the kinematics and kinetics of normal movement.” Secondly, how is the motor control affected by impairment of the structures that interact to bring about normal movement? The present review study attempted to answer the first question with regards to the control of body movement during turning.
| Methods|| |
Literature search was conducted through CINHAL, EMBASE, MEDLINE, and Google Scholar from inception to 2012 using the following search terms: coordination and turning, onset latency and turning, and peak velocity and turning. Studies on the coordination of body segments during turning in healthy individuals were retrieved from the available articles. The references of all relevant articles were also searched for more relevant articles. All articles were critically appraised for quality using relevant critical appraisal skills program tools.
Coordination of body segments during turning
Orientation of body segments to align with objects in the environment could be carried out in many positions such as sitting, standing, and walking. Studies on the relationship of the eye and head during gaze shifts in sitting healthy adults have been carried out by many authors.,,,,, However, orientation that extends beyond the range of motion of the eye and head may engage other segments for its accomplishment. Furthermore, due to the relatively wide base of support in sitting, turning the head while sitting may not be very challenging to the body's stability during the task. The narrower the base of support, the more the risk of losing stability, especially when it involves steps that cause large movement of the center of mass with respect to the base of support. Thus, turning the whole body in standing and walking may provide a great challenge to the central nervous system in coordinating the segments involved while turning to avoid losing stability.
Coordination of body segments during turning on-the-spot
Some activities of daily living involve turning on-the-spot. These tasks include turning around to respond to a call, turning to flush the toilet after use, and turning from one surface to another that are placed close to each other. Kinematics of turning on-the-spot has been investigated during both natural tasks and laboratory-based simulations of activities of daily living. Land et al. and Land  had reported sequence of rotation of eyes, head, and trunk during turns produced while three participants were making a cup of tea in a kitchen. The head began to move about 100–200 ms earlier than the eyes, and the trunk movement preceded the eyes movement by about 0.61 s in all the cases. The relationship between the head and trunk was variable; the head lagged the trunk in some turns while it led in others.
The eyes may have lagged behind the head and trunk in all situations due to the fact that objects were moved from one point to another. The eyes could have been fixed on the object that was picked in the initial stage of the turn. However, the variable relationship of the head and trunk is suggestive of the influence of some factors that determine the sequence of the segments. Factors such as baseline position of the segments, angle of the turn, and nature of the task (turning on-the-spot or while walking) could have influenced the sequence. It should be noted that the number of participants was considerably small to allow any statistical relevance to be yielded, thus the use of descriptive presentation of the data. Laboratory-based investigations of coordination of body segments during turning on-the-spot have attempted controlling some variables that could explain the variability of the sequence of the segments during turning on-the-spot. They have also recruited more participants which gave the opportunity of carrying out inferential statistics on the data collected.
There are many factors that are associated with turning the body during activities of daily living. Turns could be made toward different directions and positions. When individuals are responding to stimuli in their environment, they first of all identify where the stimulus is located such as in front, beside, or behind them and whether it is to their right or left side and then turn to the stimulus. In some instances they could be aware of the position of the stimulus (i.e., stimulus is predictable); while in other circumstances they need to locate the stimulus (i.e., stimulus is unpredictable). The predictability of a target is important in the planning of movement. When the location of a target is predictable, the brain is equipped with the information required to plan the movement prior to the start of the movement; however, when the location of the target is unpredictable, the brain depends on the sensory information provided to it at the point just before the start of the turn. This is in line with the findings that there is increased activation of motor areas of the brain with an unpredictable behavior compared to a predictable one.,
The effect of predictability of a target when turning in healthy adults has been shown in the literature. A clear top to bottom sequence of onset of rotation of body segments with eyes starting to rotate followed by the head, then trunk, and finally the feet was shown when turning to unpredictable targets., On the contrary, a more simultaneous onset of rotation of the body segments was observed when turning to predictable targets. Participants were required to turn to a specific light placed at 45°, 90°, and 135° to the right and left in a predictable manner or locate and turn to a random light (unpredictable manner) in response to a visual cue. The simultaneous onset of rotation of body segments was also shown in response to a verbal cue  when older adults where turning to predictable targets. However, young adults were shown to have separate top to bottom sequence of onset of rotation of head, trunk, and feet when instructed to turn toward a known location (predictable) starting with left foot and stepping to the beat of a metronome with their eyes closed. It is not known if the age of the participants or the instructions for the turn was responsible for the differences in the sequence of the segments.
Turn angle and direction are other factors that are associated with turning from one point to another. To successfully turn from one point to another, the brain needs to acquire information on the direction and angle of the turn through sensory systems; this information is utilized by the brain to plan the muscle activations that will take the body to the appropriate position. Activation in the primary sensorimotor area, supplementary motor area, premotor cortex, and cerebellum was found to be more with larger movement amplitude. The duration of the initial agonist burst that forms part of the triphasic pattern of muscular activation has been shown to increase with increase in movement amplitude. This implies that the onset of movement of body parts could be slower with smaller amplitudes. Indeed, this has been shown in studies of whole-body coordination during turning that the onset latency of the body segments was slower when turning to smaller angles. However, studies investigating coordination of body segments during turning on-the-spot have not reported differences in the sequence of onset of rotation of segments when turning to different angles.,
Turning behavior appears to be related to motoric dominance (handedness) due to the positive relationship that exists between the two measures. A right-sided motoric dominance and a left-sided turning preference , have been shown in healthy subjects. This means that healthy individuals prefer to turn away from their dominant side. However, the side an individual prefer to turn may not have clinical implications unless it affects the kinematics or kinetics of the movement during turning. Because the left hemisphere has been shown to be dominant in mediating cerebral activation, it would be anticipated that differences will exist in the kinematics of turning to the two different sides. However, studies that have investigated kinematics of turning have not reported differences in sequence of rotation of segments when turning to left and right (dominant and nondominant) sides.,,
The parameter that has been more widely investigated in studies looking at coordination of body segments during turning is the onset latency (reaction time). This is an important parameter for the description of motor coordination as explained by Bourbonnais et al. that a coordinated movement “is the net result of activity in several muscles that share a precise temporal and spatial pattern of onset.” The onset latency relates the movement of the segments at the start of the turn. Other important parameters that have been used to describe the relationship of movement of the segments during the turn in healthy participants are the peak velocity and time at which the peak velocity occurs.
Peak velocity/timing of peak velocity of body segments during turning on-the-spot
The peak velocity of the head has been shown to be significantly higher than that of shoulder and pelvis , during whole-body turning on-the-spot to predictable targets placed at 90°. However, the peak velocity of the shoulder and pelvis were not found to be significantly different. A similar result was obtained by Land  during turns produced in natural situations (tea making in the kitchen) where the peak velocity of the head (250–350°/s) was found to be higher than the peak velocity of the trunk (100–250°/s). Both the studies of Akram et al. and that of Solomon et al. investigated turns to predictable targets placed at 90° only. It is therefore not known if predictability and angle of the target affect the sequence of rotation of the segments. Meinhart-Shibata et al. reported no age or direction effect on peak velocity of the pelvis when young and older women turned toward the left and right to an unpredictable target placed at 180°. However, the sequence of rotation of the segments involved in the turn was not reported as the data presented was for the pelvis only.
The sequence of the time the peak velocities of the head, shoulder, and pelvis occurred has also been reported by Akram et al. during turns to predictable targets placed at 90°. The head reached its peak velocity significantly earlier than the shoulder and pelvis (0.51 ± 0.16 s, 0.65 ± 0.21 s, and 0.69 ± 0.25 s, respectively). As with the results of the peak velocity, there was no report of the effect of predictability and turn angle on the sequence of onset of rotation of the segments; furthermore, the participants turned to the right only and therefore the effect of the turn direction was also not shown.
Coordination of body segments during turning while walking
Turns are frequently superimposed on straight-ahead walking to change direction or avoid obstacles. There are many studies that have investigated the coordination of body segments during turning while walking and they have consistently shown a top-to-bottom sequence of initiation of rotation of the segments.,,, This means that the head started to rotate followed by the trunk and finally the feet. The visual cue for the start of the turn was given at the beginning of the walking pathway in a predictable manner  or one step length before the midpoint of the walking pathway in an unpredictable manner., In some instances, the participants were told which direction to turn prior to start of walking and were given a verbal instruction to start the walk., None of these conditions affected the sequence of rotation of the segments. The sequence was also consistent for the turn angles (20°, 30°, 40°, 45°, 60°, and 90°) and turn directions (left and right) investigated in the studies.
Relevance to clinical practice
The body is formed by multiple segments, each linked to the next by set of muscles. When a movement is performed by a standing subject, the geometry of the body segments is changed and as a result, the center of mass is displaced within the base of support. However, postural adjustments are available to prevent or minimize the displacement of the center of mass and thereby ensure safe performance of the movement. In a situation in which the nervous system fails to produce a coordinated movement of the body segments, the maintenance of upright stance may be jeopardized. The postural adjustments that could counteract the problem may be defective placing an individual at risk of losing stability and subsequent falls.
It is necessary to maintain upright stance during functional activities to avoid losing stability and subsequent falls. Incoordination of body segments during functional activities can challenge the maintenance of the upright stance. Frank and Earl  had postulated that maintaining upright stance during movement may involve postural preparations engaged well before movement, postural adjustments that occur simultaneously with initiation of voluntary movement, and postural reactions that occur after movement initiation. Incoordination of body segments will appear to be more challenging to the maintenance of upright stance at the initiation of the movement and during the movement. The information about the sequence of body segments at the onset of the movement and the point where the peak velocity occurs seem to coincide with these two points.
The present review has shown how factors that are associated with turning around could influence the coordination of initiation and peak velocity of body segments during turning on-the-spot and while walking. This could serve as a background upon which possible incoordination of body segments during turning could be identified in people with neurological problems.
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Conflicts of interest
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