Influence of ankle loading on the relationship between temporal pressure and motor coordination during a whole-body paired task. Exp Brain Res. 2014;232:3089-3099. [PMID: 24894588 DOI: 10.1007/s00221-014-4003-0]

Influence of Swing-Foot Strike Pattern on Balance Control Mechanisms during Gait Initiation over an Obstacle to Be Cleared

Gait initiation (GI) over an obstacle to be cleared is a functional task that is highly challenging for the balance control system. Two swing-foot strike patterns were identified during this task—the rearfoot strike (RFS), where the heel strikes the ground first, and the forefoot strike (FFS), where the toe strikes the ground first. This study investigated the effect of the swing-foot strike pattern on the postural organisation of GI over an obstacle to be cleared. Participants performed a series of obstacle clearance tasks with the instruction to strike the ground with either an FFS or RFS pattern. Results showed that anticipatory postural adjustments in the frontal plane were smaller in FFS than in RFS, while stability was increased in FFS. The vertical braking of the centre of mass (COM) during GI swing phase was attenuated in FFS compared to RFS, leading to greater downward centre of mass velocity at foot contact in FFS. In addition, the collision forces acting on the foot were smaller in FFS than in RFS, as were the slope of these forces and the slope of the C7 vertebra acceleration at foot contact. Overall, these results suggest an interdependent relationship between balance control mechanisms and foot strike pattern for optimal stability control.

Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation

Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.

Balance control during gait initiation: State-of-the-art and research perspectives

It is well known that balance control is affected by aging, neurological and orthopedic conditions. Poor balance control during gait and postural maintenance are associated with disability, falls and increased mortality. Gait initiation - the transient period between the quiet standing posture and steady state walking - is a functional task that is classically used in the literature to investigate how the central nervous system (CNS) controls balance during a whole-body movement involving change in the base of support dimensions and center of mass progression. Understanding how the CNS in able-bodied subjects exerts this control during such a challenging task is a pre-requisite to identifying motor disorders in populations with specific impairments of the postural system. It may also provide clinicians with objective measures to assess the efficiency of rehabilitation programs and better target interventions according to individual impairments. The present review thus proposes a state-of-the-art analysis on: (1) the balance control mechanisms in play during gait initiation in able bodied subjects and in the case of some frail populations; and (2) the biomechanical parameters used in the literature to quantify dynamic stability during gait initiation. Balance control mechanisms reviewed in this article included anticipatory postural adjustments, stance leg stiffness, foot placement, lateral ankle strategy, swing foot strike pattern and vertical center of mass braking. Based on this review, the following viewpoints were put forward: (1) dynamic stability during gait initiation may share a principle of homeostatic regulation similar to most physiological variables, where separate mechanisms need to be coordinated to ensure stabilization of vital variables, and consequently; and (2) rehabilitation interventions which focus on separate or isolated components of posture, balance, or gait may limit the effectiveness of current clinical practices.

Influence of temporal pressure constraint on the biomechanical organization of gait initiation made with or without an obstacle to clear

Many daily motor tasks have to be performed under a temporal pressure constraint. This study aimed to explore the influence of such constraint on motor performance and postural stability during gait initiation. Young healthy participants initiated gait at maximal velocity under two conditions of temporal pressure: in the low-pressure condition, gait was self-initiated (self-initiated condition, SI); in the high-pressure condition, it was initiated as soon as possible after an acoustic signal (reaction-time condition, RT). Gait was initiated with and without an environmental constraint in the form of an obstacle to be cleared placed in front of participants. Results showed that the duration of postural adjustments preceding swing heel-off ("anticipatory postural adjustments", APAs) was shorter, while their amplitude was larger in RT compared to SI. These larger APAs allowed the participants to reach equivalent postural stability and motor performance in both RT and SI. In addition, the duration of the execution phase of gait initiation increased greatly in the condition with an obstacle to be cleared (OBST) compared to the condition without an obstacle (NO OBST), thereby increasing lateral instability and thus involving larger mediolateral APA. Similar effects of temporal pressure were obtained in NO OBST and OBST. This study shows the adaptability of the postural system to temporal pressure in healthy young adults initiating gait. The outcome of this study may provide a basis for better understanding the aetiology of balance impairments with the risk of falling in frail populations while performing daily complex tasks involving a whole-body progression.

Age effects on the control of dynamic balance during step adjustments under temporal constraints

This study investigated the age effects on the control of dynamic balance during step adjustments under temporal constraints. Fifteen young adults and 14 older adults avoided a virtual white planar obstacle by lengthening or shortening their steps under free or constrained conditions. In the anterior-posterior direction, older adults demonstrated significantly decreased center of mass velocity at the swing foot contact under temporal constraints. Additionally, the distances between the 'extrapolated center of mass' position and base of support at the swing foot contact were greater in older adults than young adults. In the mediolateral direction, center of mass displacement was significantly increased in older adults compared with young adults. Consequently, older adults showed a significantly increased step width at the swing foot contact in the constraint condition. Overall, these data suggest that older adults demonstrate a conservative strategy to maintain anterior-posterior stability. By contrast, although older adults are able to modulate their step width to maintain mediolateral dynamic balance, age-related changes in mediolateral balance control under temporal constraints may increase the risk of falls in the lateral direction during obstacle negotiation.

Effects of temporal constraints on medio-lateral stability when negotiating obstacles

If an obstacle suddenly appears during walking, either the crossing step can be lengthened or the precrossing step shortened to avoid the obstacle. We investigated the effects of temporal constraints on dynamic stability during step adjustments. Twelve healthy young adults avoided a virtual white planar obstacle by lengthening or shortening their steps under free or constrained conditions. When constrained, participants had only one step to avoid the obstacle. The results indicated that center of mass (COM) displacement in the mediolateral (ML) direction and the COM velocity toward the swing-leg side during the crossing step were significantly increased in the long-constraint compared with the long-free condition. Consequently, the extrapolated COM (XcoM) position at the swing foot contact was also located further toward the swing-leg side. However, the distances between the XcoM and base of support (BOS) at the swing foot contact in the ML direction was unchanged because of greater lateral foot placement. In the anteriorposterior (AP) direction, temporal constraints led to greater AP COM displacement. The XcoM-BOS distance in the AP direction was unchanged in the long-constraint condition because of greater step length. However, the value became negative in the short-constraint condition, violating the conditions for dynamic stability, because step length adjustments were obstructed by the spatial constraints of the obstacles. These results suggest that temporal constraints affect postural stability in the AP and ML directions during step adjustments. AP and ML stability at swing foot contact are maintained through adjustments of step length and lateral foot placement, respectively.