{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:16:50Z","timestamp":1792678610835,"version":"4.5.0"},"reference-count":69,"publisher":"American Physiological Society","issue":"5","funder":[{"DOI":"10.13039\/501100000925","name":"Department of Health, Australian Government | National Health and Medical Research Council (NHMRC)","doi-asserted-by":"publisher","award":["1066565"],"award-info":[{"award-number":["1066565"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Neurophysiology"],"published-print":{"date-parts":[[2018,11,1]]},"abstract":"<jats:p>Postural reflexes are impaired in conditions such as Parkinson\u2019s disease, leading to difficulty walking and falls. In clinical practice, postural responses are assessed using the \u201cpull test,\u201d where an examiner tugs the prewarned standing patient backward at the shoulders and grades the response. However, validity of the pull test is debated, with issues including scaling and variability in administration and interpretation. It is unclear whether to assess the first trial or only subsequent repeated trials. The ecological relevance of a forewarned backward challenge is also debated. We therefore developed an instrumented version of the pull test to characterize responses and clarify how the test should be performed and interpreted. In 33 healthy participants, \u201cpulls\u201d were manually administered and pull force measured. Trunk and step responses were assessed with motion tracking. We probed for the StartReact phenomenon (where preprepared responses are released early by a startling stimulus) by delivering concurrent normal or \u201cstartling\u201d auditory stimuli. We found that the first pull triggers a different response, including a larger step size suggesting more destabilization. This is consistent with \u201cfirst trial effects,\u201d reported by platform translation studies, where movement execution appears confounded by startle reflex-like activity. Thus, first pull test trials have clinical relevance and should not be discarded as practice. Supportive of ecological relevance, responses to repeated pulls exhibited StartReact, as previously reported with a variety of other postural challenges, including those delivered with unexpected timing and direction. Examiner pull force significantly affected the postural response, particularly the size of stepping.<\/jats:p><jats:p>NEW &amp; NOTEWORTHY We characterized postural responses elicited by the clinical \u201cpull test\u201d using instrumentation. The first pull triggers a different response, including a larger step size suggesting more destabilization. Thus, first trials likely have important clinical and ecological relevance and should not be discarded as practice. Responses to repeated pulls can be accelerated with a startling stimulus, as reported with a variety of other challenges. Examiner pull force was a significant factor influencing the postural response.<\/jats:p>","DOI":"10.1152\/jn.00789.2017","type":"journal-article","created":{"date-parts":[[2018,8,15]],"date-time":"2018-08-15T20:40:12Z","timestamp":1534365612000},"page":"2325-2333","source":"Crossref","is-referenced-by-count":14,"title":["Neurophysiological analysis of the clinical pull test"],"prefix":"10.1152","volume":"120","author":[{"given":"Joy Lynn","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Medical Bionics, The University of Melbourne, Parkville, Victoria, Australia"},{"name":"Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thushara","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Medical Bionics, The University of Melbourne, Parkville, Victoria, Australia"},{"name":"The Bionics Institute, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"McGinley","sequence":"additional","affiliation":[{"name":"The Bionics Institute, East Melbourne, Victoria, Australia"},{"name":"Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivanthan Arthur Curtis","family":"Yohanandan","sequence":"additional","affiliation":[{"name":"The Bionics Institute, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Brown","sequence":"additional","affiliation":[{"name":"Medical Research Council Brain Network Dynamics Unit and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Thevathasan","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"The Bionics Institute, East Melbourne, Victoria, Australia"},{"name":"Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"24","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neulet.2008.02.018"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10396"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.humov.2010.11.009"},{"key":"B4","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","volume":"57","author":"Benjamini Y","year":"1995","journal-title":"J R Stat Soc B"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s004150050265"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s004150170047"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20115"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2016.05.034"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2016.10.024"},{"key":"B10","unstructured":"Campbell AD. 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