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研究生：	黃正雅 Huang, Cheng-Ya
論文名稱：	姿勢-上姿勢作業之神經動作控制 Neuromotor Control of Postural-suprapostural Tasks
指導教授：	黃英修 Hwang, Ing-Shiou
學位類別：	博士 Doctor
系所名稱：	醫學院 - 健康照護科學研究所 Institute of Allied Health Sciences
論文出版年：	2009
畢業學年度：	97
語文別：	英文
論文頁數：	134
中文關鍵詞：	注意力資源、事件相關電位、精細抓握、H反射、姿勢平衡
外文關鍵詞：	attentional resource, event-related potentials, precision grip, H reflex, postural balance
相關次數：	點閱：84 下載：7
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維持站立姿勢需有充分的注意力資源來整合前庭、視覺與本體覺之訊息，而觸覺訊息可藉由提供身體在空間的相對位置來增加站立穩定度，當執行上姿勢作業時，因同時執行上姿勢作業與維持身體穩定，需更多的注意力資源來處理感覺輸入與更新動作策略。本實驗利用手指觸覺與精細動作來探討在不同站立姿勢下，執行感覺或動作形式之上姿勢作業時，其神經控制與姿勢策略的相關性，尤其著重於觸覺方向性影響與姿勢、上姿勢作業間的交互影響。
實驗一的目的是探討站立姿勢(雙腳站、單腳站)與感覺形式之上姿勢作業(左右向手指輕觸、前後向手指輕觸)，對於比目魚肌H反射與身體壓力中心晃動的影響。受試者共執行四項作業，分別是雙腳站立、單腳站立無手指輕觸、單腳站立下手指左右向輕觸、單腳站立下手指前後向輕觸；結果發現相較於雙腳站立，當單腳站立無手指輕觸時，比目魚肌H反射顯著下降，並同時伴隨壓力中心晃動增加；而在單腳站的情況下，H反射與壓力中心晃動強度會因手指輕觸方向而調控，左右向手指輕觸下的H反射會大於前後向手指輕觸下的H反射(H反射：單腳站立下手指左右向輕觸>單腳站立下手指前後向輕觸>單腳站立無手指輕觸)，壓力中心晃動則在左右向手指輕觸下較大(壓力中心晃動：單腳站立下手指左右向輕觸<單腳站立下手指前後向輕觸<單腳站立無手指輕觸)。
實驗二的目的是探討改變姿勢-上姿勢作業困難度下，其姿勢表現與動作形式之上姿勢表現的相互影響。受試者共執行四項姿勢-上姿勢作業，分別是：雙腳站立執行固定目標之大拇指-食指精細抓握、雙腳站立執行變動目標之大拇指-食指精細抓握、單腳站立執行固定目標之大拇指-食指精細抓握、單腳站立執行變動目標之大拇指-食指精細抓握；此外，受試者執行兩項控制組作業，分別是雙腳站立與單腳站立但不執行精細抓握。實驗量測的參數有手指精細抓握的力量誤差、反應時間與身體壓力中心晃動程度。實驗結果顯示：改變姿勢與上姿勢作業困難度對手指精細抓握力量的誤差造成交互影響(固定目標：雙腳站下的誤差<單腳站下的誤差；變動目標：雙腳站下的誤差>單腳站下的誤差)，但反應時間不會受作業困難度影響；在姿勢表現方面，在單腳站情況下，執行上姿勢作業減低壓力中心晃動程度，但於雙腳站立情況下，執行上姿勢作業反而增加壓力中心晃動程度，且於固定目標的上姿式作業情況下晃動程度更為顯著(雙腳站：固定目標下的壓力中心晃動>變動目標下的壓力中心晃動)。
實驗三的目的是探討執行姿勢作業與動作形式之上姿勢作業時，大腦資源分布與資訊處理的情形。作業設計與實驗二相同，除動作表現外，本實驗另外量測大腦產生之事件相關電位與動作相關電位；實驗結果顯示：動作相關電位的發生時間與精細抓握之力量誤差，在改變姿勢與上姿勢作業困難度下有相同的交互影響(固定目標：雙腳站下的誤差、動作相關電位發生時間<單腳站下的誤差動作相關電位發生時間；變動目標：雙腳站下的誤差、動作相關電位發生時間>單腳站下的誤差、動作相關電位發生時間)；在事件相關電位上，N1成分受站立姿勢影響，單腳站立下的N1振幅在頂葉區域明顯增加，P2成分受上姿勢作業難度影響，執行變動目標之精細抓握時，右大腦半球頂葉區域的P2振幅下降。
總結以上研究發現，比目魚肌H反射與身體壓力中心晃動會受觸覺訊息的方向性影響，當觸覺方向與姿勢挑戰同向時，身體晃動會顯著減少且比目魚肌H反射會有回升的情況。此外，姿勢表現與動作形式之上姿勢表現會受作業困難度調控，上姿勢作業的反應時間與大腦的動作事件電位結果皆支持在同時執行動作形式的上姿勢作業與姿勢作業時，大腦處理資源的容量會依作業難度而擴展；本研究證明感覺與動作形式之上姿勢動作皆會影響姿勢作業的表現，高階中樞神經組織會因姿勢與上姿勢作業之相對難度而調整大腦資源分布情形。

Upright stance requires substantial attentional demands to integrate different forms of sensory information from the vestibular, visual, and proprioceptive systems. Haptic cues could facilitate postural synergy to augment stance stability for provision of body orientation respecting to the environment. When a suprapostural task is superimposed, attentional load multiplies to process extra sensory inputs and to update movement synergies for parallel execution of suprapostural task and stance maintenance at the same time. The purposes of the work were to investigate neural correlates for postural synergies in a dual-tasking, following addition of sensory or motor suprapostural task under the conditions of varying task constraints. The particular interests were directional effect of haptic stabilization and mutual influences of postural-suprapostural tasks.
For the first study, the effects of stance pattern (bilateral stance vs. unilateral stance) and directional influence of light finger touch (medial-lateral vs. anterior-posterior) in unilateral stance upon the soleus H reflex and center of pressure (CoP) sway were studied. Subjects participated in four postural tasks, including the bilateral stance (BS), the unilateral stance without finger touch (USNT), and with finger touch in the medial-lateral direction (USML) and anterior-posterior direction (USAP). In reference to the BS, the USNT resulted in a significant stance effect on suppression of the soleus H reflex (H/Mmax) associated with enhancement of CoP sway. Among the conditions of unilateral stance, there was a marked directional effect of finger touch on modulation of the H/Mmax. A greater disinhibition of the H/Mmax and a more pronounced reduction in CoP sway in consequence to light touch in the ML direction than in the AP direction was noted (H/Mmax: USML > USAP > USNT; CoP: USML < NSAP < NSNT).
In the second study, the reciprocal influences of stance pattern (bilateral stance vs. unilateral stance) and thumb-index precision grip task (static target vs. dynamic target) on postural-suprapostural tasks by manipulating task-load were studied. Subjects participated in four postural-suprapostural tasks, including static/dynamic force-matching in bilateral/unilateral stance (BS_static; US_static; BS_dynamic; US_dynamic), and two control tasks in bilateral and unilateral stances without a finger task. The normalized force error (NFE), reaction time (RT) of the finger tasks, and normalized change in center of pressure sway (ΔNCoP) were measured. For suprapostural performance, a significant interaction effect between postural and suprapostural tasks on NFE was noted (static: BS < US; dynamic: BS > US) without RT difference. For postural performance, negative ΔNCoP during unilateral stance indicated a reduction in postural sway due to added force-matching. In contrast, addition of force-matching increased postural sway during bilateral stance, but sway decreased as task-load of suprapostural task increased (BS_dynamic < BS_static).
With similar design as the second study, the third study focused on investigating interplay and resource allocation for a postural-suprapostural task with a motor suprapostural goal. On top of behavioral data, event-related potentials (ERPs) and movement-related potential (MRP) were also included in the analysis. The results showed analogue interaction effects on precision of force-matching and MRP onset depending on the suprapostural or postural tasks applied (matching error & latency of MRP onset: BS_static < US_static; BS_dynamic > US_dynamic), which was assumed to prepare for optimizing suprapostural task in various stance dynamics. From the results of ERPs, N1 component was subject to stance effect with a greater amplitude around parietal cortex across both unilateral stance conditions (N1: US > BS) associated with decreased postural sway. In contrast, P2 was differentially modulated by force-matching version with smaller amplitude over the most right parietal cortex for dynamic force-matching (P2: static > dynamic).
In summary, haptic modulation on the soleus H reflex and the degree of postural sway was directionally dependent. When finger touch was provided in line with prevailing postural threat, postural sway reduced together with disinhibition of the soleus H reflex. Next, performance of postural and suprapostural tasks could be differently modulated by task-load increment. MRP and RT results supported adaptive expansion of resource capacity for postural-suprapostural tasking with a motor suprapostural goal. Higher cortical structures must involve with flexible resource allocation, according to relative importance of postural and suprapostural tasks.

Table of Contents


Abstract	I
Abstract in Chinese	V
Acknowledgement	VIII
Table of Contents	IX
List of Tables	XI
List of Figures	XII


CHAPTER 1.	1
  INTRODUCTION

  1.1 Overview of postural-suprapostural control	1
     1.1.1 The effect of cutaneous inputs on postural performance	2
     1.1.2 The interacting effects of postural and cognitive     suprapostural task	3
  1.2 Present hypotheses of postural-suprapostural control	4
  1.3 Limitations of concurrent hypotheses for postural-suprapostural  control	6
     1.3.1 Overreaching survey based on posture-cognition setting	6
     1.3.2 Lacking sufficient neural correlates for motor synergies    during postural-suprapostural multi-tasking	7
  1.4 The specific aims of the study	9


CHAPTER 2.	11
  MODULATION OF SOLEUS H REFLEX DUE TO STANCE PATTERN AND HAPTIC STABILIZATION OF POSTURE

  2.1 Introduction	11
  2.2 Methods	13
  2.3 Results	18
  2.4 Discussion	20


CHAPTER 3.	26
  RECIPROCAL INFLUENCES ON PERFORMANCE OF A POSTURAL-SUPRAPOSTURAL TASK BY MANIPULATING THE LEVEL OF TASK LOAD

  3.1 Introduction	26
  3.2 Methods	29
  3.3 Results	36
  3.4 Discussion	38


CHAPTER 4.	42
  CONCURRENT POSTURAL AND SUPRAPOSTURAL MOTOR SYNERGIES WITH DIFFERENT TASK LOADS: BEHAVIORAL AND NEURAL CORRELATES

4.1 Introduction	42
  4.2 Methods	46
  4.3 Results	53
  4.4 Discussion	58


CHAPTER 5. 	66
  CONCLUSION AND FUTURE STUDIES
  
5.1 Conclusion	66
  5.2 Future studies	67


REFERENCES	69


Curriculum Vitae	.117
 
List of Tables

Table 1	87
The correlation between the amounts of change in H/Mmax and CoP sway due to different experimental conditions. (a) stance effect; (b) touch effect

Table 2	88
Means and standard deviations of the Mmax, Ms, Soleus RMS and TA RMS of the four stance conditions. 

Table 3. 	89
Behavior results (reaction time, normalized amplitude of postural sway, and normalized sway regularity) of the four postural-suprapostural conditions. 
 
List of Figures

Figure 1	90
Diagram of the experimental arrangement to record the soleus H reflex and postural sway. 

Figure 2.	91
Mean and standard error of H/Mmax of the soleus muscle in the four stance conditions.

Figure 3	92
Sample recordings of the H reflex for a typical subject.

Figure 4.	94
Mean and standard error of RMS of CoP amplitude in the four stance conditions.

Figure 5.	95
Sample recordings of the CoP sway for a typical subject.

Figure 6.	96
Diagram of experimental setup and recordings of physiological data for precision grip force, EMG of the first dorsal interosseous (FDI), and postural sway.

Figure 7.	97
Sample recordings of the target force and exerted force from a typical subject in two 
different suprapostural tasks. 

Figure 8.	98
Mean and standard error of normalized force error (NFE) in four different postural-suprapostural conditions.

Figure 9. 	99
Sample recordings of CoP trajectory for four postural-suprapostural tasks and two control conditions from a typical subject.

Figure 10.	100
The postural task performance of four postural-suprapostural tasks.

Figure 11.	102
(a) A schematic illustration of the auditory stimulus paradigm of the postural-suprapostural
tasks. (b) Diagram of experimental setup and recordings of physiological data.

Figure 12.	104
Sample recordings of the target force and exerted force impulses in two different 
suprapostural tasks.

Figure 13.	106
An example trial shows all physiological recordings for static force-matching during 
bilateral stance.



Figure 14.	108
The contrast of mean and standard error of normalized force error (NFE) among the four 
postural-suprapostural tasks in this study.

Figure 15.	109
(a) Scalp-recorded event-related potentials related to the execution of static force-matching 
in bilateral stance condition (BS_static). (b) Grand average waveforms from BS_static of 
the FC3 electrode recorded from 14 subjects.

Figure 16.	111
Grand average event-related potentials evoked in the ongoing force-matching for four postural-suprapostural versions in the time window between 50 ms preceding and 300 ms following executive tone.

Figure 17.	112
Topological plots showing significant postural effect and suprapostural effect on ERP amplitude.

Figure 18.	114
The contrast of mean and standard error of latency of movement-related potential onset among the four postural-suprapostural tasks in this study.  

Figure 19.	115
Topographic mapping of the MRP in all subjects.
                                    

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