Modeling margin of stability with feet in place following a postural perturbation: Effect of altered anthropometric models for estimated extrapolated centre of mass

What Is the Role of Sustained Visual Attention in the Maintenance of Postural Control in Young Adults?

Dual tasks requiring sustained visual attention and upright stance are common, yet their impact on standing balance is not well understood. We investigated the role of visual attention in the maintenance of postural control, using the multiple-object tracking (MOT) task. Healthy young adults (n = 12) performed the MOT task at three object movement speeds while seated or standing. MOT performance was assessed using tracking capacity (k). Metrics calculated to assess mediolateral (ML) and anterior-posterior (AP) postural control included: maximum difference between CoM and CoP position (CoM-CoP Max), root mean square distance for center of pressure and center of mass position (CoP and CoM RMS distance), and correlation between CoM and CoP time series signals (CoM/CoP correlation). As predicted, k decreased significantly as object movement speed increased for both standing and seated conditions. Object movement speed also significantly affected AP CoM-CoP Max in seated conditions (p = .021) and AP CoM/CoP correlation for standing conditions (p = .002). The results demonstrate utility of the MOT task in understanding the role of visual attention in postural control, even though healthy young adults were able to compensate for the addition of a sustained visual attention task, with minimal deficits to postural control.

Predicting fall risk using multiple mechanics-based metrics for a planar biped model

For both humans and robots, falls are undesirable, motivating the development of fall prediction models. Many mechanics-based fall risk metrics have been proposed and validated to varying degrees, including the extrapolated center of mass, the foot rotation index, Lyapunov exponents, joint and spatiotemporal variability, and mean spatiotemporal parameters. To obtain a best-case estimate of how well these metrics can predict fall risk both individually and in combination, this work used a planar six-link hip-knee-ankle biped model with curved feet walking at speeds ranging from 0.8 m/s to 1.2 m/s. The true number of steps to fall was determined using the mean first passage times from a Markov chain describing the gaits. In addition, each metric was estimated using the Markov chain of the gait. Because calculating the fall risk metrics from the Markov chain had not been done before, the results were validated using brute force simulations. Except for the short-term Lyapunov exponents, the Markov chains could accurately calculate the metrics. Using the Markov chain data, quadratic fall prediction models were created and evaluated. The models were further evaluated using differing length brute force simulations. None of the 49 tested fall risk metrics could accurately predict the number of steps to fall by themselves. However, when all the fall risk metrics except the Lyapunov exponents were combined into a single model, the accuracy increased substantially. These results suggest that multiple fall risk metrics must be combined to obtain a useful measure of stability. As expected, as the number of steps used to calculate the fall risk metrics increased, the accuracy and precision increased. This led to a corresponding increase in the accuracy and precision of the combined fall risk model. 300 step simulations seemed to provide the best tradeoff between accuracy and using as few steps as possible.

Small directional treadmill perturbations induce differential gait stability adaptation

Introducing unexpected perturbations to challenge gait stability is an effective approach to investigate balance control strategies. Little is known about the extent to which people can respond to small perturbations during walking. This study aimed to determine how subjects adapted gait stability to multidirectional perturbations with small magnitudes applied on a stride-by-stride basis. Ten healthy young subjects walked on a treadmill that either briefly decelerated belt speed (“stick”), accelerated belt speed (“slip”), or shifted the platform medial-laterally at right leg mid-stance. We quantified gait stability adaptation in both anterior-posterior and medial-lateral directions using margin of stability and its components, base of support, and extrapolated center of mass. Gait stability was disrupted upon initially experiencing the small perturbations as margin of stability decreased in the stick, slip, and medial shift perturbations and increased in the lateral shift perturbation. Gait stability metrics were generally disrupted more for perturbations in the coincident direction. Subjects employed both feedback and feedforward strategies in response to the small perturbations, but mostly used feedback strategies during adaptation. Subjects primarily used base of support (foot placement) control in the lateral shift perturbation and extrapolated center of mass control in the slip and medial shift perturbations. These findings provide new knowledge about the extent of gait stability adaptation to small magnitude perturbations applied on a stride-by-stride basis and reveal potential new approaches for balance training interventions to target foot placement and center of mass control.

NEW & NOTEWORTHY Little is known about if and how humans can adapt to small magnitude perturbations experienced on a stride-by-stride basis during walking. Here, we show that even small perturbations disrupted gait stability and that subjects could still adapt their reactive balance control. Depending on the perturbation direction, subjects might prefer adjusting their foot placement over their center of mass and vice versa. These findings could help potentially tune balance training to target specific aspects of balance.

Use of the margin of stability to quantify stability in pathologic gait - a qualitative systematic review

BACKGROUND

The Margin of Stability (MoS) is a widely used objective measure of dynamic stability during gait. Increasingly, researchers are using the MoS to assess the stability of pathological populations to gauge their stability capabilities and coping strategies, or as an objective marker of outcome, response to treatment or disease progression. The objectives are; to describe the types of pathological gait that are assessed using the MoS, to examine the methods used to assess MoS and to examine the way the MoS data is presented and interpreted.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) in the following databases: Web of Science, PubMed, UCL Library Explore, Cochrane Library, Scopus. All articles measured the MoS of a pathologically affected adult human population whilst walking in a straight line. Extracted data were collected per a prospectively defined list, which included: population type, method of data analysis and model building, walking tasks undertaken, and interpretation of the MoS.

RESULTS

Thirty-one studies were included in the final review. More than 15 different clinical populations were studied, most commonly post-stroke and unilateral transtibial amputee populations. Most participants were assessed in a gait laboratory using motion capture technology, whilst 2 studies used instrumented shoes. A variety of centre of mass, base of support and MoS definitions and calculations were described.

CONCLUSIONS

This is the first systematic review to assess use of the MoS and the first to consider its clinical application. Findings suggest the MoS has potential to be a helpful, objective measurement in a variety of clinically affected populations. Unfortunately, the methodology and interpretation varies, which hinders subsequent study comparisons. A lack of baseline results from large studies mean direct comparison between studies is difficult and strong conclusions are hard to make. Further work from the biomechanics community to develop reporting guidelines for MoS calculation methodology and a commitment to larger baseline studies for each pathology is welcomed.

Performance during reactive handrail grasping during forward walking by young and older adults with and without prior knowledge of the direction of movement is correlated with grip strength

It has been suggested that the most frequent cause of falls in assisted-living facilities is due to incorrect weight shifting. Lateral instability and weakness have also been linked to falls risk. The objective of this study was to evaluate balance responses to weight shifting during walking and to investigate age-related changes in movement and strength. Thirty-two participants (16 young, 16 older) completed 12 straight walking trials and 6 trials in each condition where a weight shift was required to grasp a handrail. Instructions were to walk down the pathway and, if cued, grasp the handrail as quickly as possible. Conditions included left and right grasping trials, with and without prior knowledge about the movement direction. Kinematic data were recorded and center of mass (COM) was calculated to examine whole body movements. A clinical balance test, strength, and body composition measures were captured to facilitate exploration into the relationship of these measures with reactive movements used during weight transfers. Young adults had quicker lateral COM velocities and reached peak velocity earlier. Males completed the task quicker than females and, for everyone, having knowledge about direction enabled quicker responses. Grip strength was correlated to most performance metrics in this study; more-so than body composition. Slower reactive movements might reflect a more cautious strategy in the older adults or it may highlight changes that occur with increased age and strength changes.

Untangling biomechanical differences in perturbation-induced stepping strategies for lateral balance stability in older individuals

When recovering balance from a lateral perturbation, younger adults tend to stabilize balance with a single lateral sidestep while older adults often take multistep responses. Using multiple steps to recover balance is consistently associated with increased fall risk, altered body center of mass (CoM) control and instability. The aim of this study was to compare the spatio-temporal stepping characteristics and the margin of stability (MoS) of single lateral sidesteps (LSS1) with the first and second steps of a two-step protective step sequence. Two-step sequences begin with either a cross-over step to the front or back, or a medial step followed by a lateral sidestep. Seventy-one older adults received random lateral waist-pull perturbations to either side. We hypothesized that LSS1 would be more stable (larger MoS) than either step in a two-step sequence. With some exceptions, utilizing a two-step sequence was associated with a reduced CoM velocity and distance between the base of support and CoM and decreased stability in the frontal plane following limb loading of the first and second step. There were no differences in the time available to arrest the extrapolated CoM at the end of a single lateral sidestep or the final step of a two-step sequence. Two-step sequences involving a cross-over step include more complex stepping trajectories and also challeng stability in the sagittal plane requiring a multidimensional balance correction. These results indicate important step type differences in center of mass control in recovering balance with a single lateral sidestep as opposed to a two-step sequence among older adults.

Quantifying Segmental Contributions to Center-of-Mass Motion During Dynamic Continuous Support Surface Perturbations Using Simplified Estimation Models

Investigating balance reactions following continuous, multidirectional, support surface perturbations is essential for improving our understanding of balance control in moving environments. Segmental motions are often incorporated into rapid balance reactions following external perturbations to balance, although the effects of these motions during complex, continuous perturbations have not been assessed. This study aimed to quantify the contributions of body segments (ie, trunk, head, upper extremity, and lower extremity) to the control of center-of-mass (COM) movement during continuous, multidirectional, support surface perturbations. Three-dimensional, whole-body kinematics were captured while 10 participants experienced 5 minutes of perturbations. Anteroposterior, mediolateral, and vertical COM position and velocity were calculated using a full-body model and 7 models with reduced numbers of segments, which were compared with the full-body model. With removal of body segments, errors relative to the full-body model increased, while relationship strength decreased. The inclusion of body segments appeared to affect COM measures, particularly COM velocity. Findings suggest that the body segments may provide a means of improving the control of COM motion, primarily its velocity, during continuous, multidirectional perturbations, and constitute a step toward improving our understanding of how the limbs contribute to balance control in moving environments.

Modelling the dynamic margins of stability for use in evaluations of balance following a support-surface perturbation

The dynamic margin of stability provides a method that captures the center of mass (CoM) state (position-velocity) in relation to the base of support (BoS). However, the model upon which this concept was derived does not consider how the inertial characteristics of forced support-surface perturbations would influence balance control. Within the current article, the inverted pendulum model was restructured to account for fixed, piecewise accelerations of the BoS. From this logic, two variations of the adjusted margin of stability, each maintaining a similar definition of extrapolated CoM, are proposed; one ignoring horizontal ground contact and inertial forces applied to the BoS, the other incorporating these forces. Unique within the proposed models is the time-variant BoS boundaries that depend on the perturbation applied. Verification of the solution for each model is provided, along with a comparison of obtained values to previous methods of defining CoM position-velocity stability metrics using a computational model and optimal control. For the simpler model variation (ignoring forces), we also assessed how CoM position and perturbation parameter selection over/underestimate the predicted maximal permissible velocity. The results of these analyses suggest that factors which increase the acceleration impulse decrease the difference between the two models; the opposite was observed for factors increasing displacements between the CoM and BoS boundary. Lastly, use of the proposed adjusted margin of stability within an experimental data set highlights the ability of our model to predict instability (stepping strategies; negative margin of stability) relative to the use of the extrapolated CoM alone.

The Motion of Body Center of Mass During Walking: A Review Oriented to Clinical Applications

Human walking is usually conceived as the cyclic rotation of the limbs. The goal of lower-limb movements, however, is the forward translation of the body system, which can be mechanically represented by its center of mass (CoM). Lower limbs act as struts of an inverted pendulum, allowing minimization of muscle work, from infancy to old age. The plantar flexors of the trailing limbs have been identified as the main engines of CoM propulsion. Motion of the CoM can be investigated through refined techniques, but research has been focused on the fields of human and animal physiology rather than clinical medicine. Alterations in CoM motion could reveal motor impairments that are not detectable by clinical observation. The study of the three-dimensional trajectory of the CoM motion represents a clinical frontier. After adjusting for displacement due to the average forward speed, the trajectory assumes a figure-eight shape (dubbed the “bow-tie”) with a perimeter about 18 cm long. Its lateral size decreases with walking velocity, thus ensuring dynamic stability. Lateral redirection appears as a critical phase of the step, requiring precise muscle sequencing. The shape and size of the “bow-tie” as functions of dynamically equivalent velocities do not change from child to adulthood, despite anatomical growth. The trajectory of the CoM thus appears to be a promising summary index of both balance and the neural maturation of walking. In asymmetric gaits, the affected lower limb avoids muscle work by pivoting almost passively, but extra work is required from the unaffected side during the next step, in order to keep the body system in motion. Generally, the average work to transport the CoM across a stride remains normal. In more demanding conditions, such as walking faster or uphill, the affected limb can actually provide more work; however, the unaffected limb also provides more work and asymmetry between the steps persists. This learned or acquired asymmetry is a formerly unsuspected challenge to rehabilitation attempts to restore symmetry. Techniques of selective loading of the affected side, which include constraining the motion of the unaffected limb or forcing the use of the affected limb on split-belt treadmills which impose a different velocity and power to either limb, are now under scrutiny.

Perturbation-evoked lateral steps in older adults: Why take two steps when one will do?

BACKGROUND

Hip fractures in older adults often result from a fall in the lateral direction. While younger adults tend to recover balance from a lateral perturbation with a single lateral sidestep, older adults are prone to multistep responses which are associated with an increased fall risk. This study compared the stepping characteristics and stability of single and multistep responses to lateral perturbation in healthy older adults.

METHODS

Eighty-four older adults received lateral waist-pull perturbations to either side. Spatio-temporal stepping characteristics and balance stability were quantified.

FINDINGS

Fewer steps were taken to recover balance when the first step was a lateral sidestep. The stability margin of single lateral sidesteps was greater than medial sidesteps and cross-over steps to the back but not significantly different from single cross-over steps to the front at step termination. Single step responses were more stable than multistep responses at step termination and at step initiation for lateral sidesteps and cross-over steps to the front. The decreased stability of multistep responses was attributed to an increased center of mass velocity and a smaller distance between the center of mass and base-of-support at step termination.

INTERPRETATION

Although lateral sidesteps result in fewer steps than cross-over steps to the front, the stability margin was not significantly different at step termination. These results suggest difficulty terminating center of mass motion and/or inefficient center of mass control differentiates single and multistep responses. Future studies should investigate perturbation training and/or hip abductor muscle conditioning as a means of improving compensatory stepping reactions.