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Sterke B, Jabeen S, Baines P, Vallery H, Ribbers G, Heijenbrok-Kal M. Direct biomechanical manipulation of human gait stability: A systematic review. PLoS One 2024; 19:e0305564. [PMID: 38990959 PMCID: PMC11239080 DOI: 10.1371/journal.pone.0305564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
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Affiliation(s)
- Bram Sterke
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Patricia Baines
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Heike Vallery
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Gerard Ribbers
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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2
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Cornwell T, Novotny R, Finley JM. Associations between asymmetry and reactive balance control during split-belt walking. J Biomech 2024; 172:112221. [PMID: 38972274 DOI: 10.1016/j.jbiomech.2024.112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
The adaptive control of walking is often studied on a split-belt treadmill, where people gradually reduce their step length asymmetries (SLAs) by modulating foot placement and timing. Although it is proposed that this adaptation may be driven in part by a desire to reduce instability, it is unknown if changes in asymmetry impact people's ability to maintain balance in response to destabilizing perturbations. Here, we used intermittent perturbations to determine if changes in SLA affect reactive balance control as measured by whole-body angular momentum (WBAM) in the sagittal and frontal planes. Sixteen neurotypical older adults (70.0 ± 5.3 years old; 6 males) walked on a treadmill at a 2:1 belt speed ratio with real-time visual feedback of their achieved and target step lengths. We used mixed-effects models to determine if there were associations between SLA or foot placement and WBAM during the applied perturbations. Walking with more positive SLAs was associated with small reductions in forward WBAM (p < 0.001 for fast and slow belts) but increased lateral WBAM (p = 0.045 for fast belt; p = 0.003 for slow belt) during perturbations. When participants walked with more positive SLAs, they shortened their foot placement on the slow belt, and this shortening was associated with moderate reductions in forward WBAM (p < 0.001) and small increases in lateral WBAM (p = 0.008) during slow-belt perturbations. Our findings suggest that spatiotemporal changes that occur during split-belt treadmill walking may improve sagittal-plane stability by reducing people's susceptibility to losses of balance, but this may come at the expense of frontal-plane stability.
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Affiliation(s)
- Tara Cornwell
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Ryan Novotny
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
| | - James M Finley
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA; Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
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3
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Gomez NG, Dunn JA, Gomez MA, Bo Foreman K. The effect of amplitude normalization technique, walking speed, and reporting metric on whole-body angular momentum and its interpretation during normal gait. J Biomech 2024; 168:112075. [PMID: 38631186 DOI: 10.1016/j.jbiomech.2024.112075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/09/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Whole-body angular momentum (WBAM) represents the cancellations of angular momenta that are produced during a reciprocal gait pattern. WBAM is sensitive to small changes and is used to compare dynamic gait patterns under different walking conditions. Study designs and the normalization techniques used to define WBAM vary and make comparisons between studies difficult. To address this problem, WBAM about each anatomical axis of rotation from a healthy control population during normal gait were investigated within four metrics: 1) range of WBAM, 2) integrated WBAM, 3) statistical parametric mapping (SPM), and 4) principal component analysis (PCA). These data were studied as a function of walking speed and normalization. Normalization techniques included: 1) no normalization, 2) normalization by height, body mass and walking speed, and 3) normalization by height, body mass and a scalar number, gravity×height, that is independent of walking velocity. Significant results were obtained as a function of walking speed regardless of normalization technique. However, the interpretation of significance within each metric was dependent on the normalization technique. Method 3 was the most robust technique as the differences were not altered from the expected relationships within the raw data. Method 2 actually inverted the expected relationship in WBAM amplitude as a function of walking speed, which skewed the results and their interpretation. Overall, SPM and PCA statistical methods provided better insights into differences that may be important. However, depending on the normalization technique used, caution is advised when interpreting significant findings when comparing participants with disparate walking speeds.
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Affiliation(s)
- Nicholas G Gomez
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Biomechanics Advanced, Encinitas, CA, USA.
| | - Julia A Dunn
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Mark A Gomez
- Biomechanics Advanced, Encinitas, CA, USA; Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
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4
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Wiederien RC, Gari WJ, Wilken JM. Effect of crutch and walking-boot use on whole-body angular momentum during gait. Assist Technol 2024; 36:164-172. [PMID: 37499144 PMCID: PMC10818012 DOI: 10.1080/10400435.2023.2229879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Crutches are the most prescribed ambulatory assistive device and are used for mobility and maintaining weight-bearing restrictions after injury or surgery. However, standard axillary crutches (SACs) can lead to overuse and other injuries and restrict upper limb movement. Hands-free crutches (HFC) do not restrict upper limb movement but their effect on balance control, with or without commonly prescribed walking boots, is poorly understood. The purpose of this study was to compare the effect of crutch type (SACs vs. HFC) and boot use on whole-body angular momentum (RAM), a measure of balance control. Participant's balance confidence, pain, comfort, and device preference were assessed. Seventeen participants were evaluated while walking without a crutch (NONE), with SACs, and with an HFC, and walked with and without a walking boot in each crutch condition. The gait pattern used with SACs resulted in significantly greater limb angular velocity (p < .05), and an 84% increase in RAM (p < .001) as compared to the HFC. There were no differences between the SAC and HFC for balance confidence, pain, or comfort, however most (71.1%) participants preferred the HFCs. These results suggest that individuals can better control angular momentum with the HFCs and thus may be less susceptible to loss of balance.
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Affiliation(s)
- Robert C. Wiederien
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Wesley J. Gari
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jason M. Wilken
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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5
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Curtze C, Buurke TJW, McCrum C. Notes on the margin of stability. J Biomech 2024; 166:112045. [PMID: 38484652 DOI: 10.1016/j.jbiomech.2024.112045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
The concept of the 'extrapolated center of mass (XcoM)', introduced by Hof et al., (2005, J. Biomechanics 38 (1), p. 1-8), extends the classical inverted pendulum model to dynamic situations. The vector quantity XcoM combines the center of mass position plus its velocity divided by the pendulum eigenfrequency. In this concept, the margin of stability (MoS), i.e., the minimum signed distance from the XcoM to the boundaries of the base of support was proposed as a measure of dynamic stability. Here we describe the conceptual evolution of the XcoM, discuss key considerations in the estimation of the XcoM and MoS, and provide a critical perspective on the interpretation of the MoS as a measure of instantaneous mechanical stability.
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Affiliation(s)
- Carolin Curtze
- University of Nebraska at Omaha, Department of Biomechanics, Omaha, NE, USA
| | - Tom J W Buurke
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium.
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6
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Shokouhi S, Sritharan P, Lee PVS. Recovering whole-body angular momentum and margin of stability after treadmill-induced perturbations during sloped walking in healthy young adults. Sci Rep 2024; 14:4421. [PMID: 38388724 PMCID: PMC10884438 DOI: 10.1038/s41598-024-54890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
Although humans are well-adapted to negotiating sloped terrain, balance recovery after a disturbance on slopes is poorly understood. This study investigated how slope affects recovery from unanticipated simulated trips and slips. Eighteen healthy young adults walked on a split-belt treadmill at 1.25 m/s and three slope angles (downhill: - 8°; level: 0°; uphill: + 8°), with slip- and trip-like perturbations applied randomly at heel-strike. We evaluated balance recovery using whole-body angular momentum (WBAM) and perturbation response (PR), for which larger PR values indicate greater deviation of the margin of stability from baseline, therefore, greater destabilisation after perturbation. Overall, trips were more destabilising than slips, producing larger PR and greater range and integral of WBAM across all tested slopes, most significantly in the sagittal plane. Contrary to expectation, sagittal-plane PR post-trip was greatest for level walking and smallest for downhill walking. Heightened vigilance during downhill walking may explain this finding. Recovery strategy in both frontal and sagittal planes was consistent across all slopes and perturbation types, characterized by a wider and shorter first recovery step, with trips requiring the greatest step adjustment. Our findings advance understanding of the robustness of human locomotion and may offer insights into fall prevention interventions.
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Affiliation(s)
- Shabnam Shokouhi
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Prasanna Sritharan
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Peter Vee-Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia.
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7
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Yamagata S, Yamaguchi T, Shinya M, Milosevic M, Masani K. Comparison of sensitivity among dynamic balance measures during walking with different tasks. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230883. [PMID: 38298402 PMCID: PMC10827416 DOI: 10.1098/rsos.230883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
Although various measures have been proposed to evaluate dynamic balance during walking, it is currently unclear which measures are most sensitive to dynamic balance. We aimed to investigate which dynamic balance measure is most sensitive to detecting differences in dynamic balance during walking across various gait parameters, including short- and long-term Lyapunov exponents (λs and λl), margin of stability (MOS), distance between the desired and measured centre of pressure (dCOP-mCOP) and whole-body angular momentum (WBAM). A total of 10 healthy young adults were asked to walk on a treadmill under three different conditions (normal walking, dual-task walking with a Stroop task as an unstable walking condition, and arm-restricted walking with arms restricted in front of the chest as another unstable walking condition) that were expected to have different dynamic balance properties. Overall, we found that λs of the centre of mass velocity, λs of the trunk velocity, λs of the hip joint angle, and the magnitude of the mediolateral dCOP-mCOP at heel contact can identify differences between tasks with a high sensitivity. Our findings provide new insights into the selection of sensitive dynamic balance measures during human walking.
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Affiliation(s)
| | - Takeshi Yamaguchi
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki-Aza-Aoba, Aoba-ku, Sendai, Miyagi 980-8579, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masahiro Shinya
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Matija Milosevic
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - Kei Masani
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, University Health Network, Toronto, Canada
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8
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Molitor SL, Neptune RR. Lower-limb joint quasi-stiffness in the frontal and sagittal planes during walking at different step widths. J Biomech 2024; 162:111897. [PMID: 38103312 DOI: 10.1016/j.jbiomech.2023.111897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Quasi-stiffness describes the intersegmental joint moment-angle relationship throughout the progression of a task. Previous work has explored sagittal-plane ankle quasi-stiffness and its application for the development of powered lower-limb assistive devices. However, frontal-plane quasi-stiffness remains largely unexplored but has important implications for the development of exoskeletons since clinical populations often walk with wider steps and rely on frontal-plane balance recovery strategies at the hip and ankle. This study aimed to characterize frontal-plane hip and ankle quasi-stiffness during walking and determine how step width affects quasi-stiffness in both the frontal and sagittal planes. Kinematic and kinetic data were collected and quasi-stiffness values computed for healthy young adults (n = 15) during treadmill walking across a range of step widths. We identified specific subphases of the gait cycle that exhibit linear and quadratic frontal-plane quasi-stiffness approximations for the hip and ankle, respectively. In addition, we found that at wider step widths, sagittal-plane ankle quasi-stiffness increased during early stance (∼12-35% gait cycle), sagittal-plane hip quasi-stiffness decreased in late stance (∼40-55% gait cycle) and frontal-plane hip quasi-stiffness decreased during terminal stance (∼48-65% gait cycle). These results provide a framework for further exploration of frontal-plane quasi-stiffness, lend insight into how quasi-stiffness may relate to balance control at various step widths, and motivate the development of stiffness-modulating assistive devices to improve balance related outcomes.
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Affiliation(s)
- Stephanie L Molitor
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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9
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Kazanski ME, Cusumano JP, Dingwell JB. How older adults regulate lateral stepping on narrowing walking paths. J Biomech 2023; 160:111836. [PMID: 37856977 PMCID: PMC11023624 DOI: 10.1016/j.jbiomech.2023.111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Walking humans often navigate complex, varying walking paths. To reduce falls, we must first determine how older adults purposefully vary their steps in contexts that challenge balance. Here, 20 young (21.7±2.6 yrs) and 18 older (71.6±6.0 yrs) healthy adults walked on virtual paths that slowly narrowed (from 45 cm to as narrow as 5 cm). Participants could switch onto an "easier" path whenever they chose. We applied our Goal Equivalent Manifold framework to quantify how participants adjusted their lateral stepping variability and step-to-step corrections of step width and lateral position as these paths narrowed. We also extracted these characteristics at the locations where participants switched paths. As paths narrowed, all participants reduced their lateral stepping variability, but older adults less so. To stay on the narrowing paths, young adults increasingly corrected step-to-step deviations in lateral position more, by correcting step-to-step deviations in step width less. Conversely, as older adults also increasingly corrected lateral position deviations, they did so without sacrificing correcting step-to-step deviations in step width, presumably to preserve balance. While older adults left the narrowing paths sooner, several of their lateral stepping characteristics remained similar to those of younger adults. Older adults largely maintained overall walking performance per se, but they did so by changing how they balanced the competing stepping regulation requirements intrinsic to the task: maintaining position vs. step width. Thus, balancing how to achieve multiple concurrent stepping goals while walking provides older adults the flexibility they need to appropriately adapt their stepping on continuously narrowing walking paths.
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Affiliation(s)
- Meghan E Kazanski
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B Dingwell
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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Molina LK, Small GH, Neptune RR. The influence of step width on balance control and response strategies during perturbed walking in healthy young adults. J Biomech 2023; 157:111731. [PMID: 37494856 DOI: 10.1016/j.jbiomech.2023.111731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Individuals with neuromuscular deficits often walk with wider step widths compared to healthy adults. Wider steps have been linked to a higher destabilizing frontal-plane external moment and greater range of frontal-plane whole-body angular momentum (HR), which is an indicator of decreased balance control. The purpose of this study was to experimentally determine 1) how step width alters balance control during steady-state walking, and 2) if step width changes the balance response strategies following mediolateral surface perturbations in healthy adults. Fifteen healthy young adults (7 male, age: 25 ± 4 years) walked on an instrumented treadmill at narrow, self-selected, wide and extra-wide step widths. During perturbed trials, the treadmill provided random mediolateral surface translations to each foot midway through single-leg-stance. Muscle electromyography, biomechanical measures (HR, frontal-plane external moment and joint moments) and deviations (differences in these measures between the perturbed and unperturbed walking trials) were compared across step widths. During steady state walking, wider steps were associated with decreased balance control. Increasing step widths were also associated with increased gluteus medius activity and reduced hip abduction and ankle inversion moments, which suggests healthy subjects rely more on a lateral ankle strategy to maintain balance at increasing step widths. There was no change in the plantarflexion moment. During perturbed walking, lateral, but not medial, surface translations adversely affected balance control. Further, wider steps did not change the balance response strategies following the perturbations, which suggests healthy individuals have the capacity to respond similarly to the perturbations at different step widths.
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Affiliation(s)
- Lindsey K Molina
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Gabriella H Small
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Caderby T, Lesport A, Turpin NA, Dalleau G, Watier B, Robert T, Peyrot N, Begue J. Influence of aging on the control of the whole-body angular momentum during volitional stepping: An UCM-based analysis. Exp Gerontol 2023; 178:112217. [PMID: 37224932 DOI: 10.1016/j.exger.2023.112217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
Evidence suggests that whole-body angular momentum (WBAM) is a highly controlled mechanical variable for performing our daily motor activities safely and efficiently. Recent findings have revealed that, compared to young adults, older adults exhibit larger range of WBAM during various motor tasks, such as walking and stepping. However, it remains unclear whether these age-related changes are ascribed to a poorer control of WBAM with age or not. The purpose of the present study was to examine the effect of normal aging on WBAM control during stepping. Twelve young adults and 14 healthy older adults performed a series of volitional stepping at their preferred selected speed. An Uncontrolled Manifold (UCM) analysis was conducted to explore the presence of synergies among the angular momenta of the body segments (elemental variables) to control WBAM (performance variable); i.e., to stabilize or destabilize it. Results revealed the existence of a stronger synergy destabilizing the WBAM in the sagittal-plane older adults compared to young adults during stepping, while there was no difference between the two groups in the frontal and transversal planes. Although older participants also had a larger range of WBAM in the sagittal plane compared to young adults, we found no significant correlation between synergy index and the range of WBAM in the sagittal plane. We concluded that the age-related changes in WBAM during stepping are not ascribed to alterations in the ability to control this variable with aging.
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Affiliation(s)
- Teddy Caderby
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France.
| | - Angélique Lesport
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Nicolas A Turpin
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Georges Dalleau
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
| | - Bruno Watier
- LAAS-CNRS, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Thomas Robert
- Laboratoire de Biomécanique et Mécanique des Chocs, LBMC UMR_T9406, Univ Lyon - Univ Gustave Eiffel, Lyon, France
| | - Nicolas Peyrot
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France; Mouvement - Interactions - Performance, MIP, Le Mans Université, EA 4334, 72000 Le Mans, France
| | - Jérémie Begue
- Laboratoire IRISSE, EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, France
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Moreira GM, Scrok ND, Loureiro APC, Manffra EF. Strategies Adopted by Stroke Patients to Maintain Balance in Dynamic Tasks in a Video Game. J Mot Behav 2023; 55:384-393. [PMID: 37245864 DOI: 10.1080/00222895.2023.2216150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
Postural instability affects motor tasks after a stroke. We investigated the strategies used to maintain balance during quiet standing posture and dynamic tasks in a video game. Sixteen stroke volunteers (12 males, 56 ± 9 years, post-stroke time 35 ± 10 months) and sixteen matched healthy volunteers had their biomechanical data collected to obtain the variables: center of mass, base of support, margin of stability, and weight symmetry. Healthy individuals and stroke patients showed similar dynamic stability. However, they adopted different motor strategies to achieve this: healthy individuals increased their base of support as they progressed to more challenging tasks, and stroke volunteers maintained the same base. The margin of stability of stroke volunteers was correlated with the MiniBEST scale.
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Affiliation(s)
- Gabrielly Marques Moreira
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
| | - Nicoly Dominique Scrok
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
| | - Ana Paula Cunha Loureiro
- Pontifícia Universidade Católica do Paraná, Department of Physical Therapy, School of Medicine and Life Sciences, Rua Imaculada Conceição, Curitiba, Brazil
| | - Elisangela Ferretti Manffra
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
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Cicarello NDS, Bohrer RCD, Devetak GF, Rodacki ALF, Loureiro APC, Manffra EF. Control of center of mass during gait of stroke patients: Statistical parametric mapping analysis. Clin Biomech (Bristol, Avon) 2023; 107:106005. [PMID: 37302301 DOI: 10.1016/j.clinbiomech.2023.106005] [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: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The control of the center of mass is essential for a stable and efficient gait. Post-stroke patients present several impairments, which may compromise the control of the center of mass during gait in the sagittal and frontal planes. This study aimed to identify changes in the vertical and mediolateral behavior of the center of mass during the single stance phase of post-stroke patients using the statistical parametric mapping analysis. It also aimed to identify alterations in the center of mass trajectories regarding the motor recovery stages. METHODS Seventeen stroke patients and 11 neurologically intact individuals were analyzed. The statistical parametric mapping approach was used to identify changes in the center of mass trajectories between stroke and healthy groups. The trajectories of the center of mass of post-stroke individuals were compared according to their motor recovery status. FINDINGS A near-flat vertical trajectory of the center of mass was indenfitifed in the stroke group compared to their healthy counterparts, especially on the paretic side. The center of mass trajectories in both directions (vertical and mediolateral) presented substantial alteration at the end of the single stance phase in the stroke group. The trajectory of the center of mass of the stroke group was symmetrical in the mediolateral direction between the sides. The trajectories of the center of mass presented similar pattern irrespective of the motor recovery status. INTERPRETATION The statistical parametric mapping approach showed to be suitable for determining gait changes in post-stroke individuals, irrespective of their motor recovery stage.
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Affiliation(s)
| | | | - Gisele F Devetak
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, 1155, Curitiba, Brazil; Complexo Hospital de Clínicas da Universidade Federal do Paraná, filial da Empresa Brasileira de Serviços Hospitalares (CHC-UFPR/Ebserh), Curitiba, Brazil
| | | | - Ana Paula Cunha Loureiro
- Pontifícia Universidade Católica do Paraná, Department of Physical Therapy, School of Medicine and Life Sciences, Rua Imaculada Conceição, 1155, Curitiba, Brazil.
| | - Elisangela Ferretti Manffra
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, 1155, Curitiba, Brazil
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Bansal K, Vistamehr A, Conroy CL, Fox EJ, Rose DK. The influence of backward versus forward locomotor training on gait speed and balance control post-stroke: Recovery or compensation? J Biomech 2023; 155:111644. [PMID: 37229888 DOI: 10.1016/j.jbiomech.2023.111644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Backward walking training has been reported to improve gait speed and balance post-stroke. However, it is not known if gains are achieved through recovery of the paretic limb or compensations from the nonparetic limb. The purpose of this study was to compare the influence of backward locomotor training (BLT) versus forward locomotor training (FLT) on gait speed and dynamic balance control, and to quantify the underlying mechanisms used to achieve any gains. Eighteen participants post chronic stroke were randomly assigned to receive 18 sessions of either FLT (n = 8) or BLT (n = 10). Pre- and post-intervention outcomes included gait speed (10-meter Walk Test) and forward propulsion (time integral of anterior-posterior ground-reaction-forces during late stance for each limb). Dynamic balance control was assessed using clinical (Functional Gait Assessment) and biomechanical (peak-to-peak range of whole-body angular-momentum in the frontal plane) measures. Balance confidence was assessed using the Activities-Specific Balance Confidence scale. While gait speed and balance confidence improved significantly within the BLT group, these improvements were associated with an increased nonparetic limb propulsion generation, suggesting use of compensatory mechanisms. Although there were no improvements in gait speed within the FLT group, paretic limb propulsion generation significantly improved post-FLT, suggesting recovery of the paretic limb. Neither training group improved in dynamic balance control, implying the need of balance specific training along with locomotor training to improve balance control post-stroke. Despite the within-group differences, there were no significant differences between the FLT and BLT groups in the achieved gains in any of the outcomes.
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Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Mount Union, Alliance, OH, USA.
| | - Arian Vistamehr
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Christy L Conroy
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Emily J Fox
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
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15
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Transtibial prosthetic alignment has small effects on whole-body angular momentum during functional tasks. J Biomech 2023; 149:111485. [PMID: 36780733 DOI: 10.1016/j.jbiomech.2023.111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Due to the loss of ankle function, many people with a transtibial amputation (TTA) have difficulty maintaining balance during functional tasks. Prosthetic alignment may affect how people with TTA maintain balance as it affects ground reaction forces (GRFs) and centers of pressure. We quantified the effect of prosthetic alignment on dynamic balance during several functional tasks. Ten people with TTA and 10 controls without TTA completed tasks including walking and transitioning from a chair. Participants with TTA completed all tasks with their prescribed alignment and six shifted alignments, including ±10 mm anterior/posterior, medial/lateral, and ±20 mm in the vertical direction. For each task, we quantified dynamic balance as the range of whole-body angular momentum (H→WB) and quantified trunk range of motion (ROM) and peak GRFs. Compared to controls, participants with TTA using their prescribed alignment had a greater range of H→WB in the sagittal plane during walking, in all planes during sit-to-stand, and in the transverse plane during stand-to-sit. These results were associated with GRF and trunk ROM differences between participant groups. Alignment only affected the range of H→WB in the frontal plane during walking. The larger range for the tall alignment coincided with a greater difference in vertical GRF between intact and amputated legs compared to other alignments. Our findings suggest that people with TTA can adapt to small, translational, alignment changes to maintain similar levels of dynamic balance during chair transitions. Future work should investigate alignment changes during other tasks and in lower functioning individuals.
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16
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Swing-phase pelvis perturbation improves dynamic lateral balance during walking in individuals with spinal cord injury. Exp Brain Res 2023; 241:145-160. [PMID: 36400862 DOI: 10.1007/s00221-022-06507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to determine whether the control of lateral balance can be improved by applying repeated lateral perturbation force to the pelvis during swing versus stance phase walking in individuals with spinal cord injury (SCI). Fourteen individuals with incomplete SCI were recruited in this study. Each participant visited the lab once and was tested in two experimental sessions that consisted of (1) treadmill walking with bilateral perturbation force applied to the pelvis in the lateral direction during either swing or stance phase of each leg and (2) overground walking pre- and post-treadmill walking. Applying the swing-phase perturbation during walking induced a greater increase in the muscle activation of hip abductors and ankle plantar flexors and a greater improvement in lateral balance control after the removal of perturbation force, in comparison to the results of the stance-phase perturbation condition (P ≤ 0.03). Participants also exhibited a greater reduction in overground step width and a greater improvement in overground walking speed after a session of treadmill walking practice with the swing-phase perturbation, compared with the result of the stance-phase perturbation (P = 0.01). These findings suggest that applying perturbation force to the pelvis during the swing phase of gait while walking may enhance muscle activities of hip abductors and improve lateral balance control in individuals with SCI. A walking practice with the swing-phase pelvis perturbation can be used as a rehabilitation approach to improve the control of lateral balance during walking in people with SCI.
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17
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Park S, Finley JM. Manual stabilization reveals a transient role for balance control during locomotor adaptation. J Neurophysiol 2022; 128:808-818. [PMID: 35946807 PMCID: PMC9550585 DOI: 10.1152/jn.00377.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 01/26/2023] Open
Abstract
A fundamental feature of human locomotor control is the need to adapt walking patterns in response to changes in the environment. For example, when people walk on a split-belt treadmill, which has belts that move at different speeds, they adapt to the asymmetric speed constraints by reducing spatiotemporal asymmetry. Here, we aim to understand the role of balance control as a potential factor driving this adaptation process. We recruited 24 healthy, young adults to adapt to walking on a split-belt treadmill while either holding on to a handrail or walking with free arm swing. We measured whole body angular momentum and step length asymmetry as measures of dynamic balance and spatiotemporal asymmetry, respectively. To understand how changes in intersegmental coordination influenced whole body angular momentum, we also measured segmental angular momenta and the coefficient of cancellation. When participants were initially exposed to the asymmetry in belt speeds, we observed an increase in whole body angular momentum that was due to both an increase in the momentum of individual segments and a reduction in the coefficient of cancellation. Holding on to a handrail reduced the perturbation to asymmetry during the early phase of adaptation and resulted in a smaller aftereffect during early postadaptation. In addition, the stabilization provided by holding on to a handrail led to reductions in the coupling between angular momentum and asymmetry. These results suggest that regulation of dynamic balance is most important during the initial, transient phase of adaptation to walking on a split-belt treadmill.NEW & NOTEWORTHY We investigated the role of dynamic balance during adaptation to a split-belt treadmill by measuring whole body angular momentum with or without holding on to a handrail. The initial step length asymmetry and associations between balance and asymmetry reduced when holding on to a handrail during early adaptation. These findings indicate that dynamic balance mostly contributes to the initial phase of adaptation when people are exposed to an asymmetric walking constraint.
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Affiliation(s)
- Sungwoo Park
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
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18
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Effects of age on dynamic balance measures and their correlation during walking across the adult lifespan. Sci Rep 2022; 12:14301. [PMID: 35995982 PMCID: PMC9395363 DOI: 10.1038/s41598-022-18382-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
In this study, we aimed to discover (1) the effects of age on dynamic balance measures, including the margin of stability (MOS), whole-body angular momentum (H), and misalignment of the desired and measured centers of pressure (dCOP and mCOP, respectively) in the anteroposterior (AP) and mediolateral (ML) directions, (2) the relationship between gait parameters and these balance measures, and (3) the relationships between these balance measures. We used the kinetic and kinematic data of 151 participants aged 20–77 years from a publicly available database. Participants were divided into three groups: young, middle-aged, and old. The step width of the old group was higher than that of the young group. Age-related differences in dynamic measures were found in the ML direction and not in the AP direction: MOS, peak-to-peak range of H, and dCOP–mCOP in the old group were greater than in the young group. ML MOS positively correlated with the frontal peak-to-peak range of H. The ML peak-to-peak range of H positively correlated with ML dCOP–mCOP across the adult lifespan. Our findings provide new insights for understanding the effects of age on dynamic balance and the relationships between the metrics. Older adults walked with a larger step width, resulting in a large stability margin in the ML direction, although with increased moment and momentum around the center of mass in the frontal plane.
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19
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Tsuchiyama K, Mukaino M, Ohtsuka K, Matsuda F, Tanikawa H, Yamada J, Pongpipatpaiboon K, Kanada Y, Saitoh E, Otaka Y. Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait. Eur J Phys Rehabil Med 2022; 58:352-362. [PMID: 34498833 PMCID: PMC9980585 DOI: 10.23736/s1973-9087.21.07048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability. AIM To investigate the effects of ankle-foot orthoses on post-stroke gait stability. DESIGN An experimental study with repeated measurements of gait parameters with and without orthosis. SETTING Inpatients and outpatients in the Fujita Health University Hospital, Toyoake, Japan. POPULATION Thirty-two patients (22 males; mean age 48.3±20.0 years) with post-stroke hemiparesis participated in the study. METHODS Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared. RESULTS In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041). CONCLUSIONS Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated. CLINICAL REHABILITATION IMPACT Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.
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Affiliation(s)
- Kazuhiro Tsuchiyama
- School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- School of Medicine, Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan -
| | - Kei Ohtsuka
- School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan
| | - Fumihiro Matsuda
- School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan
| | - Hiroki Tanikawa
- School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | | | - Yoshikiyo Kanada
- School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- School of Medicine, Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- School of Medicine, Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
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20
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Lin JT, Hsu CJ, Dee W, Chen D, Rymer WZ, Wu M. Anodal transcutaneous DC stimulation enhances learning of dynamic balance control during walking in humans with spinal cord injury. Exp Brain Res 2022; 240:1943-1955. [PMID: 35622090 PMCID: PMC9297533 DOI: 10.1007/s00221-022-06388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Deficits in locomotor function, including impairments in walking speed and balance, are major problems for many individuals with incomplete spinal cord injury (iSCI). However, it remains unclear which type of training paradigms are more effective in improving balance, particularly dynamic balance, in individuals with iSCI. The purpose of this study was to determine whether anodal transcutaneous spinal direct current stimulation (tsDCS) can facilitate learning of balance control during walking in individuals with iSCI. Fifteen individuals with iSCI participated in this study and were tested in two sessions (i.e., tsDCS and sham conditions). Each session consisted of 1 min of treadmill walking without stimulation or perturbation (baseline), 10 min of walking with either anodal tsDCS or sham stimulation, paired with bilateral pelvis perturbation (adaptation), and finally 2 min of walking without stimulation and perturbation (post-adaptation). The outcome measures were the dynamic balance, assessed using the minimal margin of stability (MoS), and electromyography of leg muscles. Participants demonstrated a smaller MoS during the late adaptation period for the anodal tsDCS condition compared to sham (p = 0.041), and this MoS intended to retain during the early post-adaptation period (p = 0.05). In addition, muscle activity of hip abductors was greater for the anodal tsDCS condition compared to sham during the late adaptation period and post-adaptation period (p < 0.05). Results from this study suggest that anodal tsDCS may modulate motor adaptation to pelvis perturbation and facilitate learning of dynamic balance control in individuals with iSCI.
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Affiliation(s)
- Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Seton Hall University, South Orange, NJ, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - David Chen
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - W Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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21
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Liu C, Park S, Finley J. The choice of reference point for computing sagittal plane angular momentum affects inferences about dynamic balance. PeerJ 2022; 10:e13371. [PMID: 35582618 PMCID: PMC9107787 DOI: 10.7717/peerj.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 01/13/2023] Open
Abstract
Background Measures of whole-body angular momentum in the sagittal plane are commonly used to characterize dynamic balance during human walking. To compute angular momentum, one must specify a reference point about which momentum is calculated. Although biomechanists primarily compute angular momentum about the center of mass (CoM), momentum-based controllers for humanoid robots often use the center of pressure. Here, we asked if the choice of the reference point influences interpretations of how dynamic balance is controlled in the sagittal plane during perturbed walking. Methods Eleven healthy young individuals walked on a dual-belt treadmill at their self-selected speed. Balance disturbances were generated by treadmill accelerations of varying magnitudes and directions. We computed angular momentum about two reference points: (1) the CoM or (2) the leading edge of the base of support and then projected it along the mediolateral axes that pass through either of the reference points as the sagittal plane angular momentum. We also performed principal component analysis to determine if the choice of reference point influences our interpretations of how intersegmental coordination patterns contribute to perturbation recovery. Results We found that the peak angular momentum was correlated with perturbation amplitude and the slope of this relationship did not differ between reference points. One advantage of using a reference point at the CoM is that one can easily determine how the momenta from contralateral limbs, such as the left and right legs, offset one another to regulate the whole-body angular momentum. Alternatively, analysis of coordination patterns referenced to the leading edge of the base of support may provide more insight into the inverted-pendulum dynamics of walking during responses to sudden losses of balance.
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Affiliation(s)
- Chang Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Sungwoo Park
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States of America
| | - James Finley
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
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22
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Osada Y, Motojima N, Kobayashi Y, Yamamoto S. Differences in mediolateral dynamic stability during gait initiation according to whether the non-paretic or paretic leg is used as the leading limb. PLoS One 2022; 17:e0267577. [PMID: 35476702 PMCID: PMC9045617 DOI: 10.1371/journal.pone.0267577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
We investigated mediolateral dynamic stability at first foot off and first initial contact during gait initiation according to whether the paretic or non-paretic leg was used as the leading limb. Thirty-eight individuals with stroke initiated gait with the paretic and non-paretic legs as the leading limb, and their movements were measured using a 3D motion analysis system. Margin of stability (i.e., the length between the extrapolated center of mass and lateral border of the stance foot) was used as an index of dynamic stability, with a large value indicating dynamic stability in the lateral direction. However, an excessively large margin of stability value (i.e., when the extrapolated center of mass is outside the medial border of the stance foot) indicates dynamic instability in the medial direction. Differences in the margin of stability between tasks were compared using the Wilcoxon signed-rank test. The minimum margin of stability was observed just before first foot off. When the non-paretic leg was used as the leading limb, the margin of stability tended to be excessively large at first foot off compared with when the paretic leg was used (p < 0.001). In other words, the extrapolated center of mass was outside the medial border of the paretic stance foot. In conclusion, lateral stability was achieved when using the non-paretic leading limb because the extrapolated center of mass was located outside the medial border of the stance foot. However, medial dynamic stability was lower for the non-paretic leading limb compared with the paretic leading limb.
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Affiliation(s)
- Yuji Osada
- Department of Health and Welfare Tokushima Bunri University, Tokushima, Japan
- * E-mail:
| | - Naoyuki Motojima
- Showa University School of Nursing and rehabilitation Science, Kanagawa, Japan
| | | | - Sumiko Yamamoto
- Graduate School, International University of Health & Welfare, Tokyo, Japan
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23
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Mahmood I, Raza A, Dehghani-Sanij AA. Evaluation of an adjustable ankle-foot orthosis impact on walking stability during gait transitional phases. Med Eng Phys 2022; 100:103720. [DOI: 10.1016/j.medengphy.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/19/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
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Begue J, Peyrot N, Lesport A, Turpin NA, Watier B, Dalleau G, Caderby T. Segmental contribution to whole-body angular momentum during stepping in healthy young and old adults. Sci Rep 2021; 11:19969. [PMID: 34620974 PMCID: PMC8497562 DOI: 10.1038/s41598-021-99519-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Recent evidence suggests that during volitional stepping older adults control whole-body angular momentum (H) less effectively than younger adults, which may impose a greater challenge for balance control during this task in the elderly. This study investigated the influence of aging on the segment angular momenta and their contributions to H during stepping. Eighteen old and 15 young healthy adults were instructed to perform a series of stepping at two speed conditions: preferred and as fast as possible. Full-body kinematics were recorded to compute angular momenta of the trunk, arms and legs and their contributions to total absolute H on the entire stepping movement. Results indicated that older adults exhibited larger angular momenta of the trunk and legs in the sagittal plane, which contributed to a higher sagittal plane H range during stepping compared to young adults. Results also revealed that older adults had a greater trunk contribution and lower leg contribution to total absolute H in the sagittal plane compared to young adults, even though there was no difference in the other two planes. These results stress that age-related changes in H control during stepping arise as a result of changes in trunk and leg rotational dynamics.
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Affiliation(s)
- Jérémie Begue
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France.
| | - Nicolas Peyrot
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
- Mouvement - Interactions - Performance, MIP, Le Mans Université, EA 4334, 72000, Le Mans, France
| | - Angélique Lesport
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Nicolas A Turpin
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Bruno Watier
- LAAS-CNRS, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Georges Dalleau
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
| | - Teddy Caderby
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430, Le Tampon, Ile de la Réunion, France
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Porciuncula F, Baker TC, Arumukhom Revi D, Bae J, Sloutsky R, Ellis TD, Walsh CJ, Awad LN. Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial. Front Neurorobot 2021; 15:689577. [PMID: 34393750 PMCID: PMC8356079 DOI: 10.3389/fnbot.2021.689577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/30/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Soft robotic exosuits can facilitate immediate increases in short- and long-distance walking speeds in people with post-stroke hemiparesis. We sought to assess the feasibility and rehabilitative potential of applying propulsion-augmenting exosuits as part of an individualized and progressive training program to retrain faster walking and the underlying propulsive strategy. Methods: A 54-yr old male with chronic hemiparesis completed five daily sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training. REAL training consists of high-intensity, task-specific, and progressively challenging walking practice augmented by a soft robotic exosuit and is designed to facilitate faster walking by way of increased paretic propulsion. Repeated baseline assessments of comfortable walking speed over a 2-year period provided a stable baseline from which the effects of REAL training could be elucidated. Additional outcomes included paretic propulsion, maximum walking speed, and 6-minute walk test distance. Results: Comfortable walking speed was stable at 0.96 m/s prior to training and increased by 0.30 m/s after training. Clinically meaningful increases in maximum walking speed (Δ: 0.30 m/s) and 6-minute walk test distance (Δ: 59 m) were similarly observed. Improvements in paretic peak propulsion (Δ: 2.80 %BW), propulsive power (Δ: 0.41 W/kg), and trailing limb angle (Δ: 6.2 degrees) were observed at comfortable walking speed (p's < 0.05). Likewise, improvements in paretic peak propulsion (Δ: 4.63 %BW) and trailing limb angle (Δ: 4.30 degrees) were observed at maximum walking speed (p's < 0.05). Conclusions: The REAL training program is feasible to implement after stroke and capable of facilitating rapid and meaningful improvements in paretic propulsion, walking speed, and walking distance.
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Affiliation(s)
- Franchino Porciuncula
- Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, United States.,Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Teresa C Baker
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Dheepak Arumukhom Revi
- Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, United States.,Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Jaehyun Bae
- Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, United States.,Apple Inc., Cupertino, CA, United States
| | - Regina Sloutsky
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Terry D Ellis
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Conor J Walsh
- Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, United States
| | - Louis N Awad
- Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, United States.,Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
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Watson F, Fino PC, Thornton M, Heracleous C, Loureiro R, Leong JJH. Use of the margin of stability to quantify stability in pathologic gait - a qualitative systematic review. BMC Musculoskelet Disord 2021; 22:597. [PMID: 34182955 PMCID: PMC8240253 DOI: 10.1186/s12891-021-04466-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Fraje Watson
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT, 84112, USA
| | - Matthew Thornton
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Constantinos Heracleous
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Rui Loureiro
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Julian J H Leong
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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27
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Park S, Liu C, Sánchez N, Tilson JK, Mulroy SJ, Finley JM. Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke. Neurorehabil Neural Repair 2021; 35:738-749. [PMID: 34060926 DOI: 10.1177/15459683211019346] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. OBJECTIVE We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. METHODS We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. RESULTS When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. CONCLUSIONS Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.
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Affiliation(s)
- Sungwoo Park
- University of Southern California, Los Angeles, CA, USA
| | - Chang Liu
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Sara J Mulroy
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Malloggi C, Scarano S, Cerina V, Catino L, Rota V, Tesio L. The curvature peaks of the trajectory of the body centre of mass during walking: A new index of dynamic balance. J Biomech 2021; 123:110486. [PMID: 34004391 DOI: 10.1016/j.jbiomech.2021.110486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/26/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
During walking, falling is most likely to occur towards the side of the supporting lower limb during the single stance. Timely lateral redirection of the centre of mass (CoM) preceding the no-return position is necessary for balance. We analysed the curvature peaks (the inverse of the radius of curvature) of the three-dimensional path of the CoM during the entire stride. Twelve healthy adults walked on a force-sensorized treadmill at constant velocities from 0.4 to 1.2 m s-1, in 0.2 m s-1 increments. The three-dimensional displacements of the CoM, the muscular power sustaining the CoM motion with respect to the ground, and the efficiency of the pendulum-like transfer of the CoM were computed via the double integration of the ground reaction forces. The curvatures of the CoM trajectory were measured (Frenet-Serret formula). During the single stance, the curvature showed a bell-shaped increment, lasting a few tenths of a millisecond, and peaking at 365-683 m-1 (radius of 2.7-1.4 mm, respectively), the higher the walking velocity. The CoM was redirected towards the swinging lower limb. The curvature increment was sustained by muscle-driven braking of the CoM. Smoother increments of curvature (peaking at approximately 37-150 m-1), further orienting the CoM towards the leading lower limb, were observed during the double stance. The peaks of the curvatures were symmetric between the two sides. The high curvature peaks during the single stance may represent an index of dynamic balance during walking. This index might be useful for both rehabilitation and sports training purposes.
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Affiliation(s)
- Chiara Malloggi
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Stefano Scarano
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Valeria Cerina
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Luigi Catino
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Viviana Rota
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Luigi Tesio
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
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29
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Small GH, Brough LG, Neptune RR. The influence of cognitive load on balance control during steady-state walking. J Biomech 2021; 122:110466. [PMID: 33962328 DOI: 10.1016/j.jbiomech.2021.110466] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
For an individual to successfully walk, they must maintain control of their dynamic balance. However, situations that require increased cognitive attention may impair an individual's ability to actively control their balance. While dual-task studies have analyzed walking-while-talking conditions, few studies have focused specifically on the influence of cognitive load on balance control. The purpose of this study was to assess how individuals prioritize their cognitive resources and control dynamic balance during dual-task conditions of varying difficulty. Young healthy adults (n = 15) performed two single-task conditions (spelling-while-standing and treadmill walking with no cognitive load) and three dual-task conditions (treadmill walking with increasing cognitive load: attentive listening and spelling short and long words backwards). Cognitive performance did not change between the single- and dual-task as measured by spelling percent error and response rate (p = 0.300). Balance control, assessed using the range of whole-body angular momentum, did not change between the no load and listening conditions, but decreased during the short and long spelling conditions (p < 0.001). These results highlight that in young adults balance control decreases during dual-task treadmill walking with increased cognitive loads, but their cognitive performance does not change. The decrease in balance control suggests that participants prioritized cognitive performance over balance control during these dual-task walking conditions. This work offers additional insight into the automaticity of walking and task-prioritization in healthy young individuals and provides the basis for future studies to determine differences in neurologically impaired populations.
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Affiliation(s)
- Gabriella H Small
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Lydia G Brough
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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30
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Nolasco LA, Livingston J, Silverman AK, Gates DH. The ins and outs of dynamic balance during 90-degree turns in people with a unilateral transtibial amputation. J Biomech 2021; 122:110438. [PMID: 33933867 DOI: 10.1016/j.jbiomech.2021.110438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
The ability to maintain balance when turning is essential to functional and independent living. Due to the lack of neuromuscular ankle control on the prosthetic side in people with a transtibial amputation (TTA), turning is likely more challenging. The purpose of this study was to quantify how people with TTA maintain dynamic balance during 90-degree turns made with the prosthesis on the inside and outside of the turn compared to people without amputation. Eight participants with TTA and eight age-, height-, and sex- matched non-amputee controls performed left and right 90-degree step turns at a self-selected speed. The primary outcomes were range of whole-body angular momentum and positive and negative contributions of six segment groups (head/trunk, pelvis, arms, and legs) to whole-body angular momentum during the continuation stride. Participants with TTA had greater range of frontal- and sagittal-plane whole-body angular momentum when turning with the prosthesis on the inside compared controls. They also had a greater range of whole-body angular momentum in all planes of motion when turning with the prosthesis on the inside compared to outside of the turn. The contributions for the head/trunk and inside and outside legs differed between groups and turns, suggesting altered interactions between segment momenta to compensate for the reduced contribution of the amputated leg. This study provides insight into possible training paradigms to reduce the high incidence of turn related falls in people with TTA and, potentially, ways to alter prosthetic function to promote balance control.
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Affiliation(s)
- Luis A Nolasco
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jenna Livingston
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO 80401, USA
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA.
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31
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Begue J, Peyrot N, Dalleau G, Caderby T. Effect of increasing speed on whole-body angular momentum during stepping in the elderly. J Biomech 2021; 122:110436. [PMID: 33901936 DOI: 10.1016/j.jbiomech.2021.110436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
Recent evidence suggests that older adults may have difficulty controlling whole-body angular momentum (H) during volitional stepping, which could impose a major challenge for balance control and result in potential falls. However, it is not known if and how H is influenced by speed when stepping. This study aimed to investigate the effect on H of increasing speed during step initiation in older adults. Twenty-seven healthy individuals over 60 were enrolled in the current study and were instructed to perform a series of step initiations with their dominant leg under two speed conditions: at preferred speed and as fast as possible. Two force plates and a motion-capture system were used to record H and the components of the net external moment (moment arms and ground reaction forces) during the double support and step execution phases of stepping. Results revealed that increasing speed of stepping affected H differently in both stepping phases and in the different planes. H ranges in all three planes increased with speed during the double support phase. During the step execution phase, while H ranges in frontal and transversal planes decreased, sagittal plane H range significantly increased with speed. This increased H range in the sagittal plane, which may result from the task demands, could impose a greater challenge for balance control in the elderly.
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Affiliation(s)
- Jérémie Begue
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion, France.
| | - Nicolas Peyrot
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion, France; Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000 Le Mans, France
| | - Georges Dalleau
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion, France
| | - Teddy Caderby
- Laboratoire IRISSE - EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion, France
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32
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Biomechanical response to mediolateral foot-placement perturbations during walking. J Biomech 2020; 116:110213. [PMID: 33465580 DOI: 10.1016/j.jbiomech.2020.110213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
Dynamic balance in the frontal plane requires active control, which is accomplished largely through control of mediolateral foot placement. Individuals without mobility impairments have the ability to compensate for variability in foot-placement to maintain their balance; however, it is unknown how individuals respond to unexpected mediolateral perturbations to their foot placement that alter their balance control. The purpose of this study was to identify the biomechanical responses of individuals without mobility impairments to medial and lateral foot-placement perturbations during walking. Three-dimensional body segment kinematic and ground reaction force data were collected from 15 participants at 1.0 m/s and their self-selected speed on an instrumented treadmill. Dynamic balance was assessed by analyzing whole-body angular momentum in the frontal plane. We hypothesized that participants would respond to the perturbations with a combination of a lateral ankle strategy, hip adduction strategy and/or ankle push-off strategy to restore their balance. Overall, the medial perturbations adversely affected dynamic balance while lateral perturbations had little effect. Individuals responded to medial (lateral) perturbations with an increased (decreased) ankle inversion moment, which correlated to lateral (medial) shifts in their foot center of pressure. In addition, individuals responded to medial (lateral) perturbations with a decreased (slightly decreased) hip abduction moment. Contrary to our hypothesis, we did not observe an ankle push-off moment response but rather, a small response in the opposite direction. These results highlight the response of individuals without mobility impairments to unexpected foot-placement perturbations and provide a basis of comparison for those with impaired balance control.
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33
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Zadravec M, Olenšek A, Rudolf M, Bizovičar N, Goljar N, Matjačić Z. Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects. J Neuroeng Rehabil 2020; 17:85. [PMID: 32615990 PMCID: PMC7330998 DOI: 10.1186/s12984-020-00710-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. METHODS Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. RESULTS The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions. CONCLUSIONS Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
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Affiliation(s)
- Matjaž Zadravec
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Andrej Olenšek
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Marko Rudolf
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nataša Bizovičar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nika Goljar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Zlatko Matjačić
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia.
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Liu C, Finley JM. Asymmetric gait patterns alter the reactive control of intersegmental coordination patterns in the sagittal plane during walking. PLoS One 2020; 15:e0224187. [PMID: 32437458 PMCID: PMC7241778 DOI: 10.1371/journal.pone.0224187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/30/2020] [Indexed: 11/19/2022] Open
Abstract
Recovery from perturbations during walking is primarily mediated by reactive control strategies that coordinate multiple body segments to maintain balance. Balance control is often impaired in clinical populations who walk with spatiotemporally asymmetric gait, and, as a result, rehabilitation efforts often seek to reduce asymmetries in these populations. Previous work has demonstrated that the presence of spatiotemporal asymmetries during walking does not impair the control of whole-body dynamics during perturbation recovery. However, it remains to be seen how the neuromotor system adjusts intersegmental coordination patterns to maintain invariant whole-body dynamics. Here, we determined if the neuromotor system generates stereotypical coordination patterns irrespective of the level of asymmetry or if the neuromotor system allows for variance in intersegmental coordination patterns to stabilize whole-body dynamics in the sagittal plane. Nineteen healthy participants walked on a dual-belt treadmill at a range of step length asymmetries, and they responded to unpredictable, slip-like perturbations. We used principal component analysis of segmental angular momenta to characterize intersegmental coordination patterns before, during, and after imposed perturbations. We found that two principal components were sufficient to explain ~ 95% of the variance in segmental angular momentum during both steady-state walking and responses to perturbations. Our results also revealed that walking with asymmetric step lengths led to changes in intersegmental coordination patterns during the perturbation and during subsequent recovery steps without affecting whole-body angular momentum. These results suggest that the nervous system allows for variance in segment-level coordination patterns to maintain invariant control of whole-body angular momentum during walking. Future studies exploring how these segmental coordination patterns change in individuals with asymmetries that result from neuromotor impairments can provide further insight into how the healthy and impaired nervous system regulates dynamic balance during walking.
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Affiliation(s)
- Chang Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - James M. Finley
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States of America
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35
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Lin JT, Hsu CJ, Dee W, Chen D, Rymer WZ, Wu M. Varied movement errors drive learning of dynamic balance control during walking in people with incomplete spinal cord injury: a pilot study. Exp Brain Res 2020; 238:981-993. [PMID: 32189042 DOI: 10.1007/s00221-020-05776-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine whether the application of a varied pelvis perturbation force would improve dynamic balance control and gait stability of people with incomplete spinal cord injury (iSCI). Fourteen participants with iSCI completed the test in two conditions, i.e., walking paired with pelvis perturbation force and treadmill walking only, with 1-week interval in between. The order of the testing condition was randomized across participants. For the pelvis pertubation condition, subjects walked on a treadmill with no force for 1 min, with a varied pelvis perturbation force that was bilaterally applied in the medial-lateral direction for 10 min, without force for 1 min, and then with the perturbation for another 10 min after a sitting break. For the treadmill only condition, a protocol that was similar to the perturbation condition was used but no force was applied. Margin of stability (MoS), weight shifting, and other spatiotemporal gait parameters were calculated. Compared to treadmill training only, participants showed significant smaller MoS and double-leg support time after treadmill walking with pelvis perturbation. In addition, participants showed significantly greater improvements in overground walking speed after treadmill walking with pelvis perturbation than treadmill only (p = 0.021). Results from this study suggest that applying a varied pelvis perturbation force during treadmill walking could improve dynamic balance control in people with iSCI, which could be transferred to overground walking. These findings may be used to develop a new intervention to improve balance and walking function in people with iSCI.
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Affiliation(s)
- Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - David Chen
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - W Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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Frame HB, Finetto C, Dean JC, Neptune RR. The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals. Clin Biomech (Bristol, Avon) 2020; 73:172-180. [PMID: 32004909 PMCID: PMC7183884 DOI: 10.1016/j.clinbiomech.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/19/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width. METHODS Gait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (HR) and pelvis and trunk sway. FINDINGS Controls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased HR, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment. INTERPRETATION These results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase HR, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.
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Affiliation(s)
- Hannah B Frame
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Finetto
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Sensorimotor Strategies in Individuals With Poststroke Hemiparesis When Standing Up Without Vision. Motor Control 2020; 24:150-167. [DOI: 10.1123/mc.2018-0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
Abstract
This study investigated the sensorimotor strategies for dynamic balance control in individuals with stroke by restricting sensory input that might influence task accomplishment. Sit-to-stand movements were performed with restricted vision by participants with hemiparesis and healthy controls. The authors evaluated the variability in the position of participants’ center of mass and velocity, and the center-of-pressure position, in each orthogonal direction at the lift-off point. When vision was restricted, the variability in the mediolateral center-of-pressure position decreased significantly in individuals with hemiparesis, but not in healthy controls. Participants with hemiparesis adopted strategies that explicitly differed from those used by healthy individuals. Variability may be decreased in the direction that most requires accuracy. Individuals with hemiparesis have been reported to have asymmetrical balance deficits, and that meant they had to prioritize mediolateral motion control to prevent falling. This study suggests that individuals with hemiparesis adopt strategies appropriate to their characteristics.
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Begue J, Peyrot N, Dalleau G, Caderby T. Age-related changes in the control of whole-body angular momentum during stepping. Exp Gerontol 2019; 127:110714. [DOI: 10.1016/j.exger.2019.110714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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39
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Pew C, Segal AD, Neptune RR, Klute GK. Ideal operating conditions for a variable stiffness transverse plane adapter for individuals with lower-limb amputation. J Biomech 2019; 96:109330. [DOI: 10.1016/j.jbiomech.2019.109330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
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40
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Adaptive changes in foot placement for split-belt treadmill walking in individuals with stroke. J Electromyogr Kinesiol 2019; 48:112-120. [DOI: 10.1016/j.jelekin.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/17/2019] [Accepted: 07/06/2019] [Indexed: 11/17/2022] Open
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41
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Investigation of balance strategy over gait cycle based on margin of stability. J Biomech 2019; 95:109319. [DOI: 10.1016/j.jbiomech.2019.109319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 11/18/2022]
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42
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Studying the correlation between balance assessment by Biodex Stability System and Berg Scale in stroke individuals. J Bodyw Mov Ther 2019; 23:850-854. [DOI: 10.1016/j.jbmt.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
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43
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Tesio L, Rota V. The Motion of Body Center of Mass During Walking: A Review Oriented to Clinical Applications. Front Neurol 2019; 10:999. [PMID: 31616361 PMCID: PMC6763727 DOI: 10.3389/fneur.2019.00999] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Luigi Tesio
- Department of Biomedical Sciences for Health, Università degli Studi, Milan, Italy.,Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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44
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Bruijn SM, van Dieën JH. Control of human gait stability through foot placement. J R Soc Interface 2019; 15:rsif.2017.0816. [PMID: 29875279 PMCID: PMC6030625 DOI: 10.1098/rsif.2017.0816] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/08/2018] [Indexed: 12/17/2022] Open
Abstract
During human walking, the centre of mass (CoM) is outside the base of support for most of the time, which poses a challenge to stabilizing the gait pattern. Nevertheless, most of us are able to walk without substantial problems. In this review, we aim to provide an integrative overview of how humans cope with an underactuated gait pattern. A central idea that emerges from the literature is that foot placement is crucial in maintaining a stable gait pattern. In this review, we explore this idea; we first describe mechanical models and concepts that have been used to predict how foot placement can be used to control gait stability. These concepts, such as for instance the extrapolated CoM concept, the foot placement estimator concept and the capture point concept, provide explicit predictions on where to place the foot relative to the body at each step, such that gait is stabilized. Next, we describe empirical findings on foot placement during human gait in unperturbed and perturbed conditions. We conclude that humans show behaviour that is largely in accordance with the aforementioned concepts, with foot placement being actively coordinated to body CoM kinematics during the preceding step. In this section, we also address the requirements for such control in terms of the sensory information and the motor strategies that can implement such control, as well as the parts of the central nervous system that may be involved. We show that visual, vestibular and proprioceptive information contribute to estimation of the state of the CoM. Foot placement is adjusted to variations in CoM state mainly by modulation of hip abductor muscle activity during the swing phase of gait, and this process appears to be under spinal and supraspinal, including cortical, control. We conclude with a description of how control of foot placement can be impaired in humans, using ageing as a primary example and with some reference to pathology, and we address alternative strategies available to stabilize gait, which include modulation of ankle moments in the stance leg and changes in body angular momentum, such as rapid trunk tilts. Finally, for future research, we believe that especially the integration of consideration of environmental constraints on foot placement with balance control deserves attention.
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Affiliation(s)
- Sjoerd M Bruijn
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
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45
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Bilateral temporal control determines mediolateral margins of stability in symmetric and asymmetric human walking. Sci Rep 2019; 9:12494. [PMID: 31467362 PMCID: PMC6715793 DOI: 10.1038/s41598-019-49033-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/15/2019] [Indexed: 01/10/2023] Open
Abstract
Human bipedal gait requires active control of mediolateral dynamic balance to stay upright. The margin of stability is considered a measure of dynamic balance, and larger margins are by many authors assumed to reflect better balance control. The inverted pendulum model of gait indicates that changes in the mediolateral margin of stability are related to changes in bilateral single support times. We propose updated equations for the mediolateral margin of stability in temporally symmetric and asymmetric gait, which now include the single support times of both legs. Based on these equations, we study the relation between bilateral single support times and the mediolateral margin of stability in symmetric, asymmetric, and adaptive human gait. In all conditions, the mediolateral margin of stability during walking followed predictably from bilateral single support times, whereas foot placement co-varied less with the mediolateral margin of stability. Overall, these results demonstrate that the bilateral temporal regulation of gait profoundly affects the mediolateral margin of stability. By exploiting the passive dynamics of bipedal gait, bilateral temporal control may be an efficient mechanism to safeguard dynamic stability during walking, and keep an inherently unstable moving human body upright.
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46
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Pickle NT, Shearin SM, Fey NP. Dynamic neural network approach to targeted balance assessment of individuals with and without neurological disease during non-steady-state locomotion. J Neuroeng Rehabil 2019; 16:88. [PMID: 31300001 PMCID: PMC6625014 DOI: 10.1186/s12984-019-0550-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/12/2019] [Indexed: 12/01/2022] Open
Abstract
Background Clinical balance assessments often rely on functional tasks as a proxy for balance (e.g., Timed Up and Go). In contrast, analyses of balance in research settings incorporate quantitative biomechanical measurements (e.g., whole-body angular momentum, H) using motion capture techniques. Fully instrumenting patients in the clinic is not feasible, and thus it is desirable to estimate biomechanical quantities related to balance from measurements taken from a subset of the body segments. Machine learning algorithms are well-suited for this type of low- to high-dimensional mapping. Thus, our goal was to develop and test an artificial neural network that to predict segment contributions to whole-body angular momentum from linear acceleration and angular velocity signals (i.e., those typically available to wearable inertial measurement units, IMUs) taken from a sparse set of body segments. Methods Optical motion capture data were collected from five able-bodied individuals and five individuals with Parkinson's disease (PD) walking on a non-steady-state locomotor circuit comprising stairs, ramps and changes of direction. Motion data were used to calculate angular momentum (i.e., “gold standard” output data) and body-segment linear acceleration and angular velocity data from local reference frames at the wrists, ankles and neck (i.e., network input). A dynamic nonlinear autoregressive neural network was trained using the able-bodied data (pooled across subjects). The neural network was tested on data from individuals with PD with noise added to simulate real-world IMU data. Results Correlation coefficients of the predicted segment contributions to whole-body angular momentum with the gold standard data were 0.989 for able-bodied individuals and 0.987 for individuals with PD. Mean RMS errors were between 2 and 7% peak signal magnitude for all body segments during completion of the locomotor circuits. Conclusion Our results suggest that estimating segment contributions to angular momentum from mechanical signals (linear acceleration, angular velocity) from a sparse set of body segments is a feasible method for assessing coordination of balance—even using a network trained on able-bodied data to assess individuals with neurological disease. These targeted estimates of segmental momenta could potentially be delivered to clinicians using a sparse sensor set (and likely in real-time) in order to enhance balance rehabilitation of people with PD.
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Affiliation(s)
- Nathaniel T Pickle
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX, 75080, USA.
| | - Staci M Shearin
- Department of Physical Therapy, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Nicholas P Fey
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX, 75080, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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47
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Center of mass in analysis of dynamic stability during gait following stroke: A systematic review. Gait Posture 2019; 72:154-166. [PMID: 31202025 DOI: 10.1016/j.gaitpost.2019.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Center of mass (CoM) analysis reveals important aspects of gait dynamic stability of stroke patients, but the variety of methods and measures represents a challenge for planning new studies. RESEARCH QUESTION How have the CoM measures been calculated and employed to investigate gait stability after a stroke? Three issues were addressed: (i) the methodological aspects of the calculation of CoM measures; (ii) the purposes and (iii) the conclusions of the studies on gait stability that employed those measures. METHODS PubMed and Science Direct databases have been searched to collect original articles produced until July 2017. A set of 26 studies were selected according to criteria involving their methodological quality. RESULTS A compromise between accuracy and feasibility in CoM calculation could be reached using the segmental method with 7-9 segments. Regarding their purposes, two types of studies were identified: clinical and research oriented. From the first ones, we highlighted: the margin of stability (MoS) in the mediolateral (ML) direction, and the angular momentum in the frontal plane could be indicators of dynamical stability; the MoS in the anteroposterior (AP) direction might be able to detect the risk of falls and the symmetry of vertical CoM displacement could be used to analyze energy expenditure during gait. These and other CoM measures are potentially useful in clinical settings, but their psychometric properties are still to be determined. The research oriented studies allowed to clarify that stability is not improved by widening the step in stroke patients and that the impaired control of the non-paretic limb might be the main source of instability. SIGNIFICANCE This review provides recommendations on the methods for estimating CoM and its measures, identifies the potential usefulness of CoM parameters and indicates issues that could be addressed in future studies.
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48
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Vistamehr A, Kautz SA, Bowden MG, Neptune RR. The influence of locomotor training on dynamic balance during steady-state walking post-stroke. J Biomech 2019; 89:21-27. [PMID: 30981426 DOI: 10.1016/j.jbiomech.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 12/01/2022]
Abstract
Slow walking speed and lack of balance control are common impairments post-stroke. While locomotor training often improves walking speed, its influence on dynamic balance is unclear. The goal of this study was to assess the influence of a locomotor training program on dynamic balance in individuals post-stroke during steady-state walking and determine if improvements in walking speed are associated with improved balance control. Kinematic and kinetic data were collected pre- and post-training from seventeen participants who completed a 12-week locomotor training program. Dynamic balance was quantified biomechanically (peak-to-peak range of frontal plane whole-body angular-momentum) and clinically (Berg-Balance-Scale and Dynamic-Gait-Index). To understand the underlying biomechanical mechanisms associated with changes in angular-momentum, foot placement and ground-reaction-forces were quantified. As a group, biomechanical assessments of dynamic balance did not reveal any improvements after locomotor training. However, improved dynamic balance post-training, observed in a sub-group of 10 participants (i.e., Responders), was associated with a narrowed paretic foot placement and higher paretic leg vertical ground-reaction-force impulse during late stance. Dynamic balance was not improved post-training in the remaining seven participants (i.e., Non-responders), who did not alter their foot placement and had an increased reliance on their nonparetic leg during weight-bearing. As a group, increased walking speed was not correlated with improved dynamic balance. However, a higher pre-training walking speed was associated with higher gains in dynamic balance post-training. These findings highlight the importance of the paretic leg weight bearing and mediolateral foot placement in improving frontal plane dynamic balance post-stroke.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Mark G Bowden
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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49
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Allen JL, Kesar TM, Ting LH. Motor module generalization across balance and walking is impaired after stroke. J Neurophysiol 2019; 122:277-289. [PMID: 31066611 DOI: 10.1152/jn.00561.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Muscle coordination is often impaired after stroke, leading to deficits in the control of walking and balance. In this study, we examined features of muscle coordination associated with reduced walking performance in chronic stroke survivors using motor module (a.k.a. muscle synergy) analysis. We identified differences between stroke survivors and age-similar neurotypical controls in the modular control of both overground walking and standing reactive balance. In contrast to previous studies that demonstrated reduced motor module number poststroke, our cohort of stroke survivors did not exhibit a reduction in motor module number compared with controls during either walking or reactive balance. Instead, the pool of motor modules common to walking and reactive balance was smaller, suggesting reduced generalizability of motor module function across behaviors. The motor modules common to walking and reactive balance tended to be less variable and more distinct, suggesting more reliable output compared with motor modules specific to either behavior. Greater motor module generalization in stroke survivors was associated with faster walking speed, more normal step length asymmetry, and narrower step widths. Our work is the first to show that motor module generalization across walking and balance may help to distinguish important and clinically relevant differences in walking performance across stroke survivors that would have been overlooked by examining only a single behavior. Finally, because similar relationships between motor module generalization and walking performance have been demonstrated in healthy young adults and individuals with Parkinson's disease, this suggests that motor module generalization across walking and balance may be important for well-coordinated walking. NEW & NOTEWORTHY This is the first work to simultaneously examine neuromuscular control of walking and standing reactive balance in stroke survivors. We show that motor module generalization across these behaviors (i.e., recruiting common motor modules) is reduced compared with controls and is associated with slower walking speeds, asymmetric step lengths, and larger step widths. This is true despite no between-group differences in module number, suggesting that motor module generalization across walking and balance is important for well-coordinated walking.
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Affiliation(s)
- Jessica L Allen
- Department of Chemical and Biomedical Engineering, West Virginia University , Morgantown, West Virginia
| | - Trisha M Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia
| | - Lena H Ting
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, Georgia
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50
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Pickle NT, Silverman AK, Wilken JM, Fey NP. Statistical analysis of timeseries data reveals changes in 3D segmental coordination of balance in response to prosthetic ankle power on ramps. Sci Rep 2019; 9:1272. [PMID: 30718756 PMCID: PMC6362138 DOI: 10.1038/s41598-018-37581-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022] Open
Abstract
Active ankle-foot prostheses generate mechanical power during the push-off phase of gait, which can offer advantages over passive prostheses. However, these benefits manifest primarily in joint kinetics (e.g., joint work) and energetics (e.g., metabolic cost) rather than balance (whole-body angular momentum, H), and are typically constrained to push-off. The purpose of this study was to analyze differences between active and passive prostheses and non-amputees in coordination of balance throughout gait on ramps. We used Statistical Parametric Mapping (SPM) to analyze time-series contributions of body segments (arms, legs, trunk) to three-dimensional H on uphill, downhill, and level grades. The trunk and prosthetic-side leg contributions to H at toe-off when using the active prosthesis were more similar to non-amputees compared to using a passive prosthesis. However, using either a passive or active prosthesis was different compared to non-amputees in trunk contributions to sagittal-plane H during mid-stance and transverse-plane H at toe-off. The intact side of the body was unaffected by prosthesis type. In contrast to clinical balance assessments (e.g., single-leg standing, functional reach), our analysis identifies significant changes in the mechanics of segmental coordination of balance during specific portions of the gait cycle, providing valuable biofeedback for targeted gait retraining.
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Affiliation(s)
- Nathaniel T Pickle
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, USA
| | - Jason M Wilken
- Center for the Intrepid, Brooke Army Medical Center, JBSA Ft Sam Houston, TX, 78234, USA.,Extremity Trauma and Amputation Center of Excellence, JBSA Ft Sam Houston, TX, 78234, USA
| | - Nicholas P Fey
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, 75080, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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