Proximal Postural Control Mechanisms May Be Exaggeratedly Adopted by Individuals With Peripheral Deficiencies: A Review

ABSTRACT

In quiet stance, it is understood that healthy individuals control their posture primarily by a peripheral mechanism for anteroposterior sway and by a proximal mechanism for medialateral sway. The authors proposed the hypothesis that patients suffering from disease-related deficiencies, at their feet and legs, may exaggeratedly adopt proximal control mechanisms at their hip in the anteroposterior and medialateral axes. They critically reviewed the literature to test the proximal control hypothesis against published findings. The selected articles analyzed postural control mechanisms in individuals with diabetic peripheral neuropathy and in healthy controls. The data selected were kinematic and electromyographic. In the anteroposterior axis, 4 authors had previously tested the proposed hypothesis, but the findings are contrasted. In the medialateral axis, one study failed to validate the tested hypothesis. Overall, the published studies did not conform with the proximal control hypothesis. However, these studies did not specifically or deeply test such a hypothesis. The lack of results is critical because individuals suffering from peripheral disease-related deficiencies may be unstable, in part, because of a change in postural control mechanisms. For improvement of their stability and appropriate interventions, scientific explorations of the proximal control hypothesis should be investigated. Two proposals are made to move forward.

Keywords:

• ankle–hip
• diabetic neuropathy
• load–unload
• peripheral issues
• postural strategy

ACKNOWLEDGMENTS

The authors thank Steven Ola for her efforts to improve the English in the manuscript.

Notes

1. The letter c refers to changes because the inversion–eversion mechanism is responsible for changes in the COP position. The letter v refers to vertical because the mechanism is vertically oriented with loading–unloading each foot.

2. The results of DN individuals are not discussed here, or in any other article, as explained in the Method section.