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Dubbeldam R, Lee YY, Pennone J, Mochizuki L, Le Mouel C. Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks. Eur Rev Aging Phys Act 2023; 20:2. [PMID: 36765288 PMCID: PMC9921041 DOI: 10.1186/s11556-023-00312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.
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Affiliation(s)
- Rosemary Dubbeldam
- Department of Movement Science, Institute of Sport and Exercise Science, University of Münster, Münster, Germany.
| | - Yu Yuan Lee
- grid.5949.10000 0001 2172 9288Department of Movement Science, Institute of Sport and Exercise Science, University of Münster, Münster, Germany
| | - Juliana Pennone
- grid.11899.380000 0004 1937 0722School of Arts, Sciences, and Humanities, University of São Paulo and School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Luis Mochizuki
- grid.11899.380000 0004 1937 0722School of Arts, Sciences, and Humanities, University of São Paulo and School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Charlotte Le Mouel
- Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, Paris, France
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Taborri J, Santuz A, Brüll L, Arampatzis A, Rossi S. Measuring Kinematic Response to Perturbed Locomotion in Young Adults. SENSORS 2022; 22:s22020672. [PMID: 35062633 PMCID: PMC8778052 DOI: 10.3390/s22020672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Abstract
Daily life activities often require humans to perform locomotion in challenging scenarios. In this context, this study aimed at investigating the effects induced by anterior-posterior (AP) and medio-lateral (ML) perturbations on walking. Through this aim, the experimental protocol involved 12 participants who performed three tasks on a treadmill consisting of one unperturbed and two perturbed walking tests. Inertial measurement units were used to gather lower limb kinematics. Parameters related to joint angles, as the range of motion (ROM) and its variability (CoV), as well as the inter-joint coordination in terms of continuous relative phase (CRP) were computed. The AP perturbation seemed to be more challenging causing differences with respect to normal walking in both the variability of the ROM and the CRP amplitude and variability. As ML, only the ankle showed different behavior in terms of joint angle and CRP variability. In both tasks, a shortening of the stance was found. The findings should be considered when implementing perturbed rehabilitative protocols for falling reduction.
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Affiliation(s)
- Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany; (A.S.); (L.B.); (A.A.)
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
| | - Leon Brüll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany; (A.S.); (L.B.); (A.A.)
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Network Aging Research, Heidelberg University, 69117 Heidelberg, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany; (A.S.); (L.B.); (A.A.)
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
- Correspondence: ; Tel.: +39-07-6135-7049
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Farinelli V, Bolzoni F, Marchese SM, Esposti R, Cavallari P. A Novel Viewpoint on the Anticipatory Postural Adjustments During Gait Initiation. Front Hum Neurosci 2021; 15:709780. [PMID: 34707487 PMCID: PMC8543010 DOI: 10.3389/fnhum.2021.709780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Anticipatory postural adjustments (APAs) are the coordinated muscular activities that precede the voluntary movements to counteract the associated postural perturbations. Many studies about gait initiation call APAs those activities that precede the heel-off of the leading foot, thus taking heel-off as the onset of voluntary movement. In particular, leg muscles drive the center of pressure (CoP) both laterally, to shift the body weight over the trailing foot and backward, to create a disequilibrium torque pushing forward the center of mass (CoM). However, since subjects want to propel their body rather than lift their foot, the onset of gait should be the CoM displacement, which starts with the backward CoP shift. If so, the leg muscles driving such a shift are the prime movers. Moreover, since the disequilibrium torque is mechanically equivalent to a forward force acting at the pelvis level, APAs should be required to link the body segments to the pelvis: distributing such concentrated force throughout the body would make all segments move homogeneously. In the aim of testing this hypothesis, we analyzed gait initiation in 15 right-footed healthy subjects, searching for activities in trunk muscles that precede the onset of the backward CoP shift. Subjects stood on a force plate for about 10 s and then started walking at their natural speed. A minimum of 10 trials were collected. A force plate measured the CoP position while wireless probes recorded the electromyographic activities. Recordings ascertained that at gait onset APAs develop in trunk muscles. On the right side, Rectus Abdominis and Obliquus Abdominis were activated in 11 and 13 subjects, respectively, starting on average 33 and 54 ms before the CoP shift; Erector Spinae (ES) at L2 and T3 levels was instead inhibited (9 and 7 subjects, 104 and 120 ms). On the contralateral side, the same muscles showed excitatory APAs (abdominals in 11 and 12 subjects, 27 and 82 ms; ES in 10 and 7 subjects, 75 and 32 ms). The results of this study provide a novel framework for distinguishing postural from voluntary actions, which may be relevant for the diagnosis and rehabilitation of gait disorders.
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Affiliation(s)
- Veronica Farinelli
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bolzoni
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Silvia Maria Marchese
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Esposti
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Cavallari
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Grabowiecki M, Rum L, Laudani L, Vannozzi G. Biomechanical characteristics of handstand walking initiation. Gait Posture 2021; 86:311-318. [PMID: 33839425 DOI: 10.1016/j.gaitpost.2021.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The initiation in human locomotion is defined as the transition between upright stance and steady-state gait. While past literature abundantly investigated the initiation in bipedal gait, the initiation of handstand walking remains unexplored. RESEARCH QUESTION The current study aims to characterise the centre of pressure (CoP) and centre of mass (CoM) trajectory of handstand walking initiation as well as the spatiotemporal and kinematic parameters and balance strategy of this task. Also, the study examined the CoP trajectory similarity within- and between-participants using a coefficient of multiple correlation analysis. METHODS Nineteen gymnasts took part in this study. Handstand walking initiation trials were recorded using force plates and a stereophotogrammetric system. CoM and CoP trajectories were analysed during the Baseline, Preparation and Execution phases of the motor task. RESULTS We found that to successfully perform the handstand walking initiation, a shift of the CoM forward and towards the stance hand is required as a result of a lateral and posterior CoP shift. All participants performed a similar CoP pattern in the mediolateral direction, whereas two anteroposterior CoP displacement strategies were identified across participants based on different timing execution of posterior CoP shift. While CoP and CoM kinematic differences were identified during the Preparation Phase due to the adopted strategy, no significant difference was found in the Execution Phase for the spatiotemporal and kinematic characteristics. SIGNIFICANCE A better understanding of the required CoP/CoM patterns and balance control provides the basis for further neuromechanics research on the topic and could contribute to individualise training protocols to improve the learning of the task.
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Affiliation(s)
- Michal Grabowiecki
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, CF23 6XD, Cardiff, UK
| | - Lorenzo Rum
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, CF23 6XD, Cardiff, UK
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
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Filho SS, Coelho DB, Ugrinowitsch C, de Souza CR, Magalhães FH, de Lima-Pardini AC, de Oliveira ÉMB, Mattos E, Teixeira LA, Silva-Batista C. Age-Related Changes in Presynaptic Inhibition During Gait Initiation. J Gerontol A Biol Sci Med Sci 2021; 76:568-575. [PMID: 33428714 DOI: 10.1093/gerona/glab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 01/05/2023] Open
Abstract
Age-related changes in presynaptic inhibition (PSI) have not been observed during gait initiation, which requires anticipatory postural adjustment (APA). As APA is centrally modulated and is impaired in older compared to young adults, here we aimed to study the presynaptic control and co-contraction levels in the ankle muscles during gait initiation in older compared to young adults. Fifteen older (age range 65-80 years) and 15 young adults (age range 19-30 years) performed a gait initiation task on a force platform under 3 conditions: (i) without electrical stimulation; (ii) test Hoffman reflex (H-reflex); and (iii) conditioned H-reflex. H-reflexes were evoked on the soleus muscle when the APA amplitude exceeded 10%-20% of the average baseline mediolateral force. Participants also performed quiet stance as a control task. Results showed that both age groups presented similar PSI levels during quiet stance (p = .941), while in the gait initiation older adults presented higher PSI levels, longer duration, and lower amplitude of APA than young adults (p < .05). Older adults presented higher co-contraction ratio in both tasks than young adults (p < .05). Correlations between the PSI levels and the APA amplitude (r = -0.61, p = .008), and between the PSI levels and the co-contraction ratio during gait initiation (r = -0.64, p = .005) were found for older adults only. APA amplitude explained 49% of the variance of the PSI levels (p = .003). Our findings suggest that older compared to young adults have increased presynaptic control to compensate for the decreased supraspinal modulation on impaired APAs during gait initiation.
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Affiliation(s)
- Solival Santos Filho
- Exercise Neuroscience Research Group, University of São Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.,Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, Brazil
| | - Carlos Ugrinowitsch
- Laboratory of Strength Training, School of Physical Education and Sport, University of São Paulo, Brazil
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, Brazil
| | | | | | | | - Eugenia Mattos
- Exercise Neuroscience Research Group, University of São Paulo, Brazil
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Brazil
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Shinohara T, Saida K, Miyata K. Ability of the Brief-Balance Evaluation Systems Test to evaluate balance deficits in community-dwelling older adults: a cross-sectional study. Physiother Theory Pract 2020; 38:1381-1388. [PMID: 33289587 DOI: 10.1080/09593985.2020.1840682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A method for assessing balance that differentiates between balance deficit can help guide effective interventions for preventing falls in older adults. OBJECTIVE This study aimed to clarify the relationship between balance control systems and falls, and to examine the ability of the Brief-Balance Evaluation Systems Test (BESTest) to evaluate balance deficits in older adults. METHODS Overall, 109 community-dwelling older adults participated in this study. The history of falls in the last year was investigated. Balance deficits were assessed using the Brief-BESTest, the functional reach test, the Timed up and Go Test, and the one leg balance test. We analyzed the difference between the fallers and non-fallers across two different age groups. RESULTS Among younger-older group participants (age < 75 years), there were no significant differences between fallers and non-fallers across all variables. Among older-older group participants (age ≥ 75 years), there were significant differences in the Brief-BESTest total (p= .011; fallers, 13.5 versus non-fallers, 17.0) and section IV scores (postural responses of the Brief-BESTest; p= .026, 2.0 versus 5.0). There was no significant difference in other balance measurements. CONCLUSIONS The postural responses assessed by the Brief-BESTest may serve important functions and may be associated with falls in older adults.
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Affiliation(s)
- Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-Shi, Japan
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-Shi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
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