1
|
Tiwari A, Joshi D. Design and Validation of a Real-Time Visual Feedback System to Improve Minimum Toe Clearance (mTC) in Transfemoral Amputees. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1711-1722. [PMID: 34398756 DOI: 10.1109/tnsre.2021.3105139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tripping is accompanied by reduced minimum toe clearance (mTC) during the swing phase of gait. The risk of fall due to tripping among transfemoral amputees is nearly 67% which is greater than the transtibial amputees. Therefore, intervention to improve mTC can potentially enhance the quality of life among transfemoral amputees. In this paper, we first develop a real-time visual feedback system with center of pressure (CoP) information. Next, we recruited six non-disabled and three transfemoral amputees to investigate the effect on mTC while participants were trained to shift the CoP anteriorly/posteriorly during heel strike. Finally, to assess the lasting effect of training on mTC, retention trials were conducted without feedback. During feedback, posterior shift in the CoP improved the mTC significantly from 4.68 ± 0.40 cm to 6.12 ± 0.68 cm (p < 0.025) in non-disabled participants. A similar significant improvement in mTC from 4.60 ± 0.55 cm to 5.62 ± 0.57 cm was observed in amputees during posterior shift of CoP. Besides mTC, maximal toe clearances, i.e., maxTC1 and maxTC2, also showed a significant increase (p < 0.025) during the posterior shift of CoP in both the participants. Moreover, during retention, mTC did not differ significantly (p > 0.05) from feedback condition in amputee, suggesting a positive effect of feedback training. The foot-to-ground angle (FGA) at mTC increased significantly (p < 0.025) during posterior shift feedback in non-disabled suggests active ankle dorsiflexion in increasing mTC. However, in amputees, FGA at mTC did not differ significantly during both anterior and posterior CoP shift feedback. The present findings suggest CoP feedback as a potential strategy during gait rehabilitation of transfemoral amputees.
Collapse
|
2
|
Muir BC, Haddad JM, van Emmerik REA, Rietdyk S. Changes in the control of obstacle crossing in middle age become evident as gait task difficulty increases. Gait Posture 2019; 70:254-259. [PMID: 30909004 DOI: 10.1016/j.gaitpost.2019.01.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Age-associated physiological changes result in modified gait, such as slower speed, for older adults. Identifying the onset of age-related gait changes will provide insight into the role of aging on locomotor control. It is expected that a more challenging gait task (obstacle crossing) puts more demands on physiological systems, and may reveal gait modifications in a middle-aged group that are not evident in an easier gait task (level walking). RESEARCH QUESTION To identify the effect of advancing age on gait as a function of increasing locomotor challenge during an obstacle crossing task. METHODS Three age groups (young, middle-aged, and older adults) stepped over an obstacle placed in a 15 m walkway. Task challenge ranged from low to high in four conditions: unobstructed gait, 3, 10, and 26 cm obstacles. Gait measures were calculated during the approach and crossing steps. RESULTS Significant interactions were observed for gait speed (age by height by step, p < 0.01), foot placement variability (age by step, p < 0.01) and foot clearance (age by height, p = 0.05). Relative to young adults, older adults walked slower in all conditions and had higher foot clearances for the 10 and 26 cm obstacles. Middle-aged adults walked with speeds and foot clearances that were not different from young adults in the lower gait challenge conditions, and changed to values that were not different from older adults in the highest gait challenge conditions. Foot placement variability was greater for the middle-aged and older groups, but only in the last two steps before the obstacle. SIGNIFICANCE Multiple gait changes were observed as early as middle-age, and changes in speed and foot clearance became more evident as task difficulty increased. The increased gait challenge placed more demands on the neuromuscular system, revealing age-related gait modifications that were not evident in the level walking gait task.
Collapse
Affiliation(s)
- B C Muir
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; RR&D Center for Limb Loss and MoBility (CLiMB), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
| | - J M Haddad
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - R E A van Emmerik
- Department of Kinesiology University of Massachusetts, Amherst, MA, USA
| | - S Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
3
|
Worden TA, Vallis LA. Examining Transfer Effects of Dual-Task Training Protocols for a Complex Locomotor Task. J Mot Behav 2017. [PMID: 28644923 DOI: 10.1080/00222895.2017.1327409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Training protocols designed to improve dual-task performance of an obstacle crossing and auditory Stroop task (OBS+Stroop) were tested. In Experiment 1 , following baseline collection of OBS+Stroop trials, proximally related walking training was performed, and participants were then retested on the OBS+Stroop test. After training, participants adopted a more cautious obstacle crossing strategy, indicating a potentially safer navigation strategy. Transfer effects from distally related training were then examined (Experiment 2 ); a computer game training paradigm was examined using the same testing protocol as Experiment 1 . Computer training demonstrated improved dual-task performance on some measures, but did not induce a more cautious stepping strategy. Results indicate that dual-task training needs to be similar to targeted tasks to yield reliable, positive training outcomes.
Collapse
Affiliation(s)
- Timothy A Worden
- a Department of Human Health and Nutritional Sciences , University of Guelph , Guelph , Ontario , Canada
| | - Lori Ann Vallis
- a Department of Human Health and Nutritional Sciences , University of Guelph , Guelph , Ontario , Canada.,b The Schlegel-University of Waterloo Research Institute for Aging (RIA) , Waterloo , Ontario , Canada
| |
Collapse
|
4
|
Singhal K, Kim J, Casebolt J, Lee S, Han KH, Kwon YH. Gender difference in older adult's utilization of gravitational and ground reaction force in regulation of angular momentum during stair descent. Hum Mov Sci 2015; 41:230-9. [PMID: 25846952 DOI: 10.1016/j.humov.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/14/2015] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
Abstract
Angular momentum of the body is a highly controlled quantity signifying stability, therefore, it is essential to understand its regulation during stair descent. The purpose of this study was to investigate how older adults use gravity and ground reaction force to regulate the angular momentum of the body during stair descent. A total of 28 participants (12 male and 16 female; 68.5 years and 69.0 years of mean age respectively) performed stair descent from a level walk in a step-over-step manner at a self-selected speed over a custom made three-step staircase with embedded force plates. Kinematic and force data were used to calculate angular momentum, gravitational moment, and ground reaction force moment about the stance foot center of pressure. Women show a significantly greater change in normalized angular momentum (0.92Nms/Kgm; p=.004) as compared to men (0.45Nms/Kgm). Women produce higher normalized GRF (p=.031) during the double support phase. The angular momentum changes show largest backward regulation for Step 0 and forward regulation for Step 2. This greater difference in overall change in the angular momentum in women may explain their increased risk of fall over the stairs.
Collapse
Affiliation(s)
- Kunal Singhal
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States.
| | - Jemin Kim
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Jeffrey Casebolt
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Sangwoo Lee
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Ki-Hoon Han
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Young-Hoo Kwon
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| |
Collapse
|
5
|
Li Z, Chang CC, DiDomenico A, Qi C, Chiu SL. Investigating gait adjustments and body sway while walking across wooden scaffold boards. ERGONOMICS 2015; 58:1581-1588. [PMID: 25679262 DOI: 10.1080/00140139.2015.1015620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The flexible wooden boards are still being used on the scaffolds at some construction worksites in China. We examined if the board dimension, acclimation phase and construction work experience influence workers' walking strategies on these boards. Among the 40 construction workers recruited, half of them had more than 1 year of construction work experience. The participants' body sway and the gait adjustments were captured and analysed. Our analysis showed the width and thickness of the boards had significant effects on walking speed. There is a significant interaction between construction experience and board width on stride width, whereas the interaction between construction experience and acclimation phase affects step length and walking speed. The body sway at the C6/C7 and L5/S1 locations are significantly affected by most of the factors. We also found that once the participants acclimated to the board condition, the sway variability increased. Practitioner Summary: This study investigated gait and postural adjustments of workers with different construction experience while walking over wooden scaffold boards, which is one of the activities highly associated with falling accidents in China.
Collapse
Affiliation(s)
- Zhizhong Li
- a Department of Industrial Engineering , Tsinghua University , Beijing 100084 , P.R. China
| | | | | | | | | |
Collapse
|
6
|
Muir BC, Haddad JM, Heijnen MJH, Rietdyk S. Proactive gait strategies to mitigate risk of obstacle contact are more prevalent with advancing age. Gait Posture 2015; 41:233-9. [PMID: 25455212 DOI: 10.1016/j.gaitpost.2014.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/28/2014] [Accepted: 10/06/2014] [Indexed: 02/02/2023]
Abstract
The purposes of this study were to determine if healthy older adults adopt strategies to decrease the likelihood of obstacle contact, and to determine how these strategies are modified as a function of advancing age. Three age groups were examined: 20-25 yo (N = 19), 65-79 yo (N = 11), and 80-91 yo (N = 18). Participants stepped over a stationary, visible obstacle on a walkway. Step length and gait speed progressively decreased with advancing age; the shorter step length resulted in closer foot placement to the obstacle and an associated increased risk of obstacle contact. Lead (first limb to cross the obstacle) and trail (second) limb trajectories were examined for behavior that mitigated the risk of contact. (1) Consistent trail foot placement before the obstacle across all ages allowed space and time for the trail foot to clear the obstacle. (2) To avoid lead limb contact due to closer foot placement before and after the obstacle, the lead toe was raised more vertically after toe-off, and then the foot was extended beyond the landing position (termed lead overshoot) and retracted backwards to achieve the shortened step length. Lead overshoot progressively increased with advancing age. (3) Head angle was progressively lower with advancing age, an apparent attempt to gather more visual information during approach. Overall, a series of proactive strategies were adopted to mitigate risk of contact. However, the larger, more abrupt movements associated with a more vertical foot trajectory and lead overshoot may compromise whole body balance, indicating a possible trade-off between risk of contact and stability.
Collapse
Affiliation(s)
- B C Muir
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - J M Haddad
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - M J H Heijnen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - S Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA.
| |
Collapse
|
7
|
Lu ML, Kincl L, Lowe B, Succop P, Bhattacharya A. Muscular activity of lower limb muscles associated with working on inclined surfaces. ERGONOMICS 2014; 58:278-290. [PMID: 25331562 PMCID: PMC4557765 DOI: 10.1080/00140139.2014.968634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study investigated the effects of visual cues, muscular fatigue, task performance and experience of working on inclined surfaces on activity of postural muscles in the lower limbs associated with maintaining balance on three inclined surfaces - 0°, 14° and 26°. Normalised electromyographic (NEMG) data were collected in 44 professional roofers bilaterally from the rectus femoris, biceps femoris, tibialii anterior and gastrocnemii medial muscle groups. The 50th and 95th percentile NEMG amplitudes were used as EMG variables. Results showed that inclination angle and task performance caused a significant increase in the NEMG amplitudes of all postural muscles. Visual cues were significantly associated with a decrease in the 95th percentile EMG amplitude for the right gastrocnemius medial and tibialis anterior. Fatigue was related to a significant decrease in the NEMG amplitude for the rectus femoris. Experience of working on inclined surfaces did not have a significant effect on the NEMG amplitude.
Collapse
Affiliation(s)
- Ming-Lun Lu
- National Institute for Occupational Safety and Health, Taft Laboratories, 4676 Columbia Parkway MS C-24, Cincinnati, OH 45226, USA
| | - Laurel Kincl
- College of Public Health and Human Sciences, Oregon State University, 14B Milam Hall, Corvallis, OR 97331, USA
| | - Brian Lowe
- National Institute for Occupational Safety and Health, Taft Laboratories, 4676 Columbia Parkway MS C-24, Cincinnati, OH 45226, USA
| | - Paul Succop
- Division of Epidemiology and Biostatistics, University of Cincinnati Medical College, 123 E. Shield St., Cincinnati, Ohio, USA
| | - Amit Bhattacharya
- Biomechanics/Ergonomics Research Laboratories, University of Cincinnati Medical College, 123 E. Shield St., Cincinnati, Ohio, USA
| |
Collapse
|
8
|
Abstract
Routine activities performed while standing and walking require the ability to appropriately and continuously modulate postural movements as a function of a concurrent task. Changes in task-dependent postural control contribute to the emergence, maturation, and decline of complex motor skills and stability throughout the lifespan.
Collapse
|
9
|
Rietdyk S, Rhea CK. The effect of the visual characteristics of obstacles on risk of tripping and gait parameters during locomotion. Ophthalmic Physiol Opt 2011; 31:302-10. [PMID: 21470274 DOI: 10.1111/j.1475-1313.2011.00837.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Injuries from falls are a serious health issue. Approaches to preventing falls should consider increasing relevant visual information of an obstacle. Obstacle parameters, such as position and height, may be specified by the visible structure of an obstacle. The present study examined the relationship between visible structure of an obstacle and locomotor behaviour. This relationship may be modified as a function of experience with navigating obstacles. Since workers at construction sites must navigate through cluttered environments with varied obstacles, these workers may have superior skills at avoiding obstacles. Therefore, the effect of work experience was also examined. METHODS Nine construction workers and 10 age- and gender-matched control subjects participated. Subjects stepped over obstacles in an 8 m walkway. Three different obstacles were examined, arranged according to a hierarchy ranging from most to least visible structure: a solid obstacle, a three-edge outline obstacle and a top-edge obstacle. The obstacles were 10, 20 or 30 cm high. In addition, visual information was decreased with goggles which obstructed the lower visual field, removing information of the obstacle and foot-relative-to-obstacle in the two steps before the obstacle. All conditions were presented randomly. RESULTS Higher risk of contact and higher lead and trail toe clearance variability were observed for the top-edge obstacle. Higher risk of contact was observed when the lower visual field was obstructed and for the 30 cm obstacle. Work experience did not influence risk of contact. Construction workers had lower trail toe clearances and lower trail toe clearance variability for the 10 cm obstacle, but were not different from controls for the 30 cm obstacle. CONCLUSIONS Decreased visible structure of an obstacle resulted in increased gait variability and increased risk of contact. The changes are consistent with decreased accuracy of the sensory-to-motor transformation used to control the lead and trail limb during obstacle crossing when only the top-edge was visible. There is some evidence that construction workers were better able to transform the visual information to motor actions, as reflected by decreased gait variability, but these findings were not supported by decreased risk of obstacle contact.
Collapse
Affiliation(s)
- Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, USA.
| | | |
Collapse
|
10
|
Differential integration of visual and kinaesthetic signals to upright stance. Exp Brain Res 2011; 212:33-46. [DOI: 10.1007/s00221-011-2693-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
|
11
|
Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds. J Biomech 2011; 44:379-85. [DOI: 10.1016/j.jbiomech.2010.10.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/21/2022]
|