Journal of Neural Transmission

, Volume 114, Issue 10, pp 1279–1296 | Cite as

Cognitive demands and cortical control of human balance-recovery reactions

  • B. E. Maki
  • W. E. McIlroy


A traditional view has been that balance control occurs at a very automatic level, primarily involving the spinal cord and brainstem; however, there is growing evidence that the cerebral cortex and cognitive processing are involved in controlling specific aspects of balance. The purpose of this review is to summarize recent literature pertaining to the cognitive demands and cortical control of balance-recovery reactions, focussing on five emerging sources of evidence: 1) dual-task studies demonstrating that concurrent performance of cognitive and balance-recovery tasks leads to interference effects; 2) dual-task studies that have examined the temporal dynamics associated with the reallocation of cognitive resources to the balance-recovery task; 3) visual attention studies that have inferred contributions of visual attention based on gaze measurements and/or manipulations to occlude vision; 4) measurements of brain potentials evoked by postural perturbation; and 5) use of transcranial magnetic stimulation to alter contributions from specific cortical areas.


Attentional dynamics automatic postural response dual-task interference electroencephalography evoked potentials eye movements gaze grasping postural balance reaching saccades stepping transcranial magnetic stimulation triggered reactions visual attention 



anticipatory postural adjustment


automatic postural response


central nervous system


center of foot pressure






repetitive transcranial magnetic stimulation


transcranial magnetic stimulation


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ackermann, H, Diener, HC, Dichgans, J 1986Mechanically evoked cerebral potentials and long-latency muscle responses in the evaluation of afferent and efferent long-loop pathways in humansNeurosci Lett66233238CrossRefPubMedGoogle Scholar
  2. Adkin, A, Quant, S, Maki, BE, McIlroy, WE 2006Cortical responses associated with predictable and unpredictable compensatory balance reactionsExp Brain Res1728593CrossRefPubMedGoogle Scholar
  3. Alexander, NB, Mollo, JM, Giordani, B, Ashton-Miller, JA, Schultz, AB, Grunawalt, JA, Foster, NL 1995Maintenance of balance, gait patterns, and obstacle clearance in Alzheimer’s diseaseNeurology45908914PubMedGoogle Scholar
  4. Brauer, SG, Woollacott, M, Shumway-Cook, A 2002The influence of a concurrent cognitive task on the compensatory stepping response to a perturbation in balance-impaired and healthy eldersGait Posture158393CrossRefPubMedGoogle Scholar
  5. Brown, LA, Shumway-Cook, A, Woollacott, MH 1999Attentional demands and postural recovery: the effects of agingJ Gerontol54AM165M171Google Scholar
  6. Cejka, C, Lee, TA, McIlroy, WE, Maki, BE 2005Gaze behavior associated with the response to an unexpected balance perturbation while walking in an unfamiliar environmentGait Posture21S24CrossRefGoogle Scholar
  7. Chong, RKY, Jones, CL, Horak, FB 1999Postural set for balance control is normal in Alzheimer’s but not in Parkinson’s diseaseJ Gerontol54M129M135Google Scholar
  8. Dietz, V 1992Human neuronal control of automatic functional movements: interaction between central programs and afferent inputPhysiol Rev723369PubMedGoogle Scholar
  9. Dietz, V, Quintern, J, Berger, W 1984Cerebral evoked potentials associated with the compensatory reactions following stance and gait perturbationNeurosci Lett50181186CrossRefPubMedGoogle Scholar
  10. Dietz, V, Quintern, J, Berger, W 1985aAfferent control of human stance and gait: evidence for blocking of group I afferents during gaitExp Brain Res61153163CrossRefGoogle Scholar
  11. Dietz, V, Quintern, J, Berger, W, Schenk, E 1985bCerebral potentials and leg muscle e.m.g. responses associated with stance perturbationExp Brain Res57354384CrossRefGoogle Scholar
  12. Dimitrov, B, Gavrilenko, T, Gatev, P 1996Mechanically evoked cerebral potentials to sudden ankle dorsiflexion in human subjects during standingNeurosci Lett208199202CrossRefPubMedGoogle Scholar
  13. Duckrow, RB, Abu-Hasaballah, K, Whipple, R, Wolfson, L 1999Stance perturbation-evoked potentials in old people with poor gait and balanceClin Neurophysiol11020262032CrossRefPubMedGoogle Scholar
  14. Ghafouri, M, McIlroy, WE, Maki, BE 2004Initiation of rapid reach-and-grasp balance reactions: is a pre-formed visuospatial map used in controlling the initial arm trajectory?Exp Brain Res155532536CrossRefPubMedGoogle Scholar
  15. Gordon, R, Rzempoluck, EJ 2004Introduction to laplacian montagesAm J Electroneurodiagn Technol4498102Google Scholar
  16. Horak, FB 1995Adaptation of automatic postural responsesBloedel, JEbner, TJWise, SP eds. Acquisition of motor behavior in vertebratesMIT PressCambridge, MAGoogle Scholar
  17. Horak, FB, MacPherson, JM 1996Postural orientation and equilibriumShepard, JRowell, L eds. Handbook of physiology. Exercise: regulation and integration of multiple systemsOxford University PressNew York255292Google Scholar
  18. Keck, ME, Pijnappels, M, Schubert, M, Colombo, G, Curt, A, Dietz, V 1998Stumbling reactions in man: influence of corticospinal input. Electromyography Motor Control ElectroencephalogrClin Neurophysiol109215223Google Scholar
  19. Kerr, B, Condon, SM, McDonald, LA 1985Cognitive spatial processing and the regulation of postureJ Exp Psychol11617622Google Scholar
  20. King EC, Lee TA, Maki BE (2007) Does peripheral vision contribute to online control of grasping reactions evoked by unexpected perturbation when walking in an unfamiliar environment? Gait Posture (suppl; in press)Google Scholar
  21. Lajoie, BA, Cody, FWJ, Capaday, C 1995Cortical control of human soleus muscle during volitional and postural activities studied using focal magnetic stimulationExp Brain Res10397107Google Scholar
  22. Lee TA, McKay SM, Peters AL, Maki BE (2007) Age-related differences in reach-to-grasp reactions and associated gaze behavior evoked by unexpected perturbation when walking in an unfamiliar environment. Gait Posture (suppl; in press)Google Scholar
  23. Macpherson, JM, Fung, J, Jacobs, R 1997Postural orientation, equilibrium, and the spinal cordAdv Neurol72227232PubMedGoogle Scholar
  24. Maeda, F, Keenan, JP, Tormos, JM, Topka, H, Pascual-Leone, A 2000Interindividual variability of the modulatory effects of repetitive transcranial magnetic stimulation on cortical excitabilityExp Brain Res133425430CrossRefPubMedGoogle Scholar
  25. Maki BE (2007) Postural strategies. In: Binder MD, Hirokawa N, Windhorst U (eds) Encyclopedia of neuroscience. Springer, New York (in press)Google Scholar
  26. Maki, BE, McIlroy, WE 1997The role of limb movements in maintaining upright stance: the “change-in-support” strategyPhys Ther77488507PubMedGoogle Scholar
  27. Maki, BE, McIlroy, WE 2005Change-in-support balance reactions in older persons: an emerging research area of clinical importanceFurman, JMWhitney, SL eds. Neurologic clinicsElsevierPhiladelphia751783Google Scholar
  28. Maki, BE, McIlroy, WE, Fernie, GR 2003Change-in-support reactions for balance recovery: control mechanisms, age-related changes and implications for fall preventionIEEE Eng Med Biol Magaz222026CrossRefGoogle Scholar
  29. Maki, BE, Norrie, RG, Zecevic, A, Quant, S, Kirshenbaum, N, Bateni, H, McIlroy, WE 2001aInitiation and execution of rapid postural reactions and stepping movements: which phases require visuospatial attention?Duysens, JSmits-Engelsman, BCMKingma, H eds. Control of posture and gaitInternational Society for Postural and Gait ResearchMaastricht, Netherlands573576Google Scholar
  30. Maki BE, Perry SD, Scovil CY, Mihailidis A, Fernie GR (2006) Getting a grip on stairs: research to optimize effectiveness of handrails. In: Pikaar RN, Koningsveld EAP, Settels PJM (eds) Proc, IEA2006 Congress, (article #778) Elsevier, Amsterdam pp 4669–4674Google Scholar
  31. Maki, BE, Zecevic, A, Bateni, H, Kirshenbaum, N, McIlroy, WE 2001bCognitive demands of executing rapid postural reactions: does aging impede attentional switching?NeuroReport1235833587CrossRefGoogle Scholar
  32. Mansfield AM, Peters AP, Liu BA, Maki BE (2007) A perturbation-based balance training program for older adults: study protocol for a randomised controlled trial. BioMed Central Geriatrics (in press)Google Scholar
  33. Massion, J 1991Movement, posture and equilibrium: interaction and coordinationProg Neurobiol383556CrossRefGoogle Scholar
  34. McIlroy, WE, Maki, BE 1993Do anticipatory postural adjustments precede compensatory stepping reactions evoked by perturbation?Neurosci Lett164199204CrossRefPubMedGoogle Scholar
  35. McIlroy, WE, Maki, BE 1994The ‘deceleration response’ to transient perturbation of upright stanceNeurosci Lett1751316CrossRefPubMedGoogle Scholar
  36. McIlroy, WE, Maki, BE 1995Adaptive changes to compensatory stepping responsesGait Posture34350CrossRefGoogle Scholar
  37. McIlroy, WE, Maki, BE 1999The control of lateral stability during rapid stepping reactions evoked by antero-posterior perturbation: does anticipatory control play a role?Gait Posture9190198CrossRefPubMedGoogle Scholar
  38. McIlroy, WE, Norrie, RG, Brooke, JD, Bishop, DC, Nelson, AJ, Maki, BE 1999Temporal properties of attention sharing consequent to disturbed balanceNeuroReport1028952899CrossRefPubMedGoogle Scholar
  39. McKay SM, Peters AL, Scovil CY, Lee TA, Maki BE (2007) Do age-related deficits in visual processing predict impaired control of change-in-support balance-recovery reactions? Gait Posture (suppl; in press)Google Scholar
  40. Muller, MLTM, Redfern, MS, Furman, JM, Jennings, JR 2004Effect of preparation on dual-task performance in postural controlJ Motor Behav36137146CrossRefGoogle Scholar
  41. Nashner, LM, McCollum, G 1985The organization of human postural movements: a formal basis and experimental synthesisBehav Brain Sci8135172CrossRefGoogle Scholar
  42. Norrie, RG, Maki, BE, Staines, WR, McIlroy, WE 2002The time course of attention shifts following perturbation of upright stanceExp Brain Res146315321CrossRefPubMedGoogle Scholar
  43. Pashler, HE 1999The psychology of attentionMIT PressCambridge, MAGoogle Scholar
  44. Quant, S, Adkin, A, Staines, WR, Maki, BE, McIlroy, WE 2004aThe effect of a concurrent cognitive task on cortical potentials evoked by unpredictable balance perturbationsBioMed Central Neurosci518Google Scholar
  45. Quant, S, Adkin, A, Staines, WR, McIlroy, WE 2004bCortical activation following a balance disturbanceExp Brain Res155393400CrossRefGoogle Scholar
  46. Quant, S, Maki, BE, McIlroy, WE 2005The association between later cortical potentials and later phases of postural reactions evoked by perturbations to upright stanceNeurosci Lett381269274CrossRefPubMedGoogle Scholar
  47. Rankin, J, Woollacott, MH, Shumway-Cook, A, Brown, L 2000Cognitive influence on postural stability: a neuromuscular analysis in young and eldersJ Gerontol55AM112M119Google Scholar
  48. Redfern, MS, Muller, ML, Jennings, JR, Furman, JM 2002Attentional dynamics in postural control during perturbations in young and older adultsJ Gerontol57B298B303Google Scholar
  49. Schröger, E 1996A neural mechanism for involuntary attention shifts to changes in auditory stimulationJ Cogn Neurosci8527539CrossRefGoogle Scholar
  50. Scovil CY, Zettel JL, King EC, Maki BE (2007) Stepping to recover balance in complex environments: is online visual control necessary or sufficient? Gait Posture (suppl; in press)Google Scholar
  51. Shumway-Cook, A, Brauer, S, Woollacott, MH 2000Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go testPhys Ther80896903PubMedGoogle Scholar
  52. Shumway-Cook, A, Woollacott, M, Kerns, KA, Baldwin, M 1997The effects of two types of cognitive tasks on postural stability in older adults with and without a history of fallingJ Gerontol52AM232M240Google Scholar
  53. Solopova, IA, Kazennikov, OV, Deniskina, NB, Levik, YS, Ivanenko, YP 2003Postural instability enhances motor responses to transcranial magnetic stimulation in humansNeurosci Lett3372528CrossRefPubMedGoogle Scholar
  54. Staines, WR, McIlroy, WE, Brooke, JD 2001Cortical representation of whole-body movement is modulated by proprioceptive discharge in humansExp Brain Res138235242CrossRefPubMedGoogle Scholar
  55. Stewart, L, Ellisen, A, Walsh, V, Cowey, A 2001The role of transcranial magnetic stimulation (TMS) in studies of vision, attention and cognitionActa Psychol107275291CrossRefGoogle Scholar
  56. Taube, W, Schubert, M, Gruber, M, Beck, S, Faist, M, Gollhofer, A 2006Direct corticospinal pathways contribute to neuromuscular control of perturbed stanceJ Appl Physiol101420429CrossRefPubMedGoogle Scholar
  57. Ward, NS, Franckowiak, RS 2003Age-related changes in the neural correlates of motor performanceBrain126873888CrossRefPubMedGoogle Scholar
  58. Wikswo, JPJ, Gevins, A, Williamson, SJ 1993The future of the EEG and MEGElectroencephalog Clin Neurophysiol8719CrossRefGoogle Scholar
  59. Woollacott, M, Shumway-Cook, A 2002Attention and the control of posture and gait: a review of an emerging area of researchGait Posture16114CrossRefPubMedGoogle Scholar
  60. Yardley, L, Gardner, M, Leadbetter, A, Lavie, N 1999Effect of articulatory and mental tasks on postural controlNeuroReport10215219CrossRefPubMedGoogle Scholar
  61. Zettel, JL, Holbeche, A, McIlroy, WE, Maki, BE 2005aRedirection of gaze and switching of attention during rapid stepping reactions evoked by unpredictable postural perturbationExp Brain Res165392410CrossRefGoogle Scholar
  62. Zettel, JL, McIlroy, WE, Maki, BE 2002Can stabilizing features of rapid triggered stepping reactions be modulated to meet environmental constraints?Exp Brain Res145297308CrossRefPubMedGoogle Scholar
  63. Zettel, JL, McIlroy, WE, Maki, BE 2005bGaze behavior and the modulation of triggered stepping reactions to meet environmental demands in older adultsGait Posture21S12CrossRefGoogle Scholar
  64. Zettel, JL, McIlroy, WE, Maki, BE 2005cVisual behavior governing rapid stepping reactions in the presence of dynamic and unpredictable obstaclesGait Posture21S21CrossRefGoogle Scholar
  65. Zettel JL (2006) Gaze behavior and visuospatial attention in compensatory stepping responses. Doctoral dissertation. University of Toronto, Toronto, CanadaGoogle Scholar
  66. Zettel JL, McIlroy WE, Maki BE (2007) Effect of competing attentional demands on perturbation-evoked stepping reactions and associated gaze behavior in young and older adults. Gait Posture (suppl; in press)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • B. E. Maki
    • 1
    • 2
    • 3
  • W. E. McIlroy
    • 1
    • 2
    • 3
    • 4
  1. 1.Sunnybrook Health Sciences CentreTorontoCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.Toronto Rehabilitation InstituteTorontoCanada
  4. 4.University of WaterlooWaterlooCanada

Personalised recommendations