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van Dieën JH, Bruijn SM, Afschrift M. Assessment of stabilizing feedback control of walking: A tutorial. J Electromyogr Kinesiol 2024; 78:102915. [PMID: 38936234 DOI: 10.1016/j.jelekin.2024.102915] [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: 01/22/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
Walking without falling requires stabilization of the trajectory of the body center of mass relative to the base of support. Model studies suggest that this requires active, feedback control, i.e., the nervous system must process sensory information on the state of the body to generate descending motor commands to the muscles to stabilize walking, especially in the mediolateral direction. Stabilization of bipedal gait is challenging and can be impaired in older and diseased individuals. In this tutorial, we illustrate how gait analysis can be used to assess the stabilizing feedback control of gait. We present methods ranging from those that require limited input data (e.g. position data of markers placed on the feet and pelvis only) to those that require full-body kinematics and electromyography. Analyses range from simple kinematics analyses to inverse dynamics. These methods assess stabilizing feedback control of human walking at three levels: 1) the level of center of mass movement and horizontal ground reaction forces, 2) the level of center of mass movement and foot placement and 3) the level of center of mass movement and the joint moments or muscle activity. We show how these can be calculated and provide a GitHub repository (https://github.com/VU-HMS/Tutorial-stabilizing-walking) which contains open access Matlab and Python code to calculate these. Finally, we discuss what information on feedback control can be learned from each of these.
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Affiliation(s)
- Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Maarten Afschrift
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Howard KE, Reimold NK, Knight HL, Embry AE, Knapp HA, Agne AA, Jacobs CJ, Dean JC. Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke. Gait Posture 2024; 109:9-14. [PMID: 38237508 PMCID: PMC10939767 DOI: 10.1016/j.gaitpost.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. RESEARCH QUESTION Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? METHODS In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. RESULTS Only ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SIGNIFICANCE While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.
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Affiliation(s)
- Keith E Howard
- College of Health Professions; Medical University of South Carolina, USA
| | - Nicholas K Reimold
- College of Health Professions; Medical University of South Carolina, USA
| | - Heather L Knight
- College of Health Professions; Medical University of South Carolina, USA
| | - Aaron E Embry
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA
| | - Holly A Knapp
- College of Health Professions; Medical University of South Carolina, USA
| | - Alexa A Agne
- College of Health Professions; Medical University of South Carolina, USA
| | - Camden J Jacobs
- College of Health Professions; Medical University of South Carolina, USA
| | - Jesse C Dean
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA.
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Mahaki M, van Leeuwen AM, Bruijn SM, van der Velde N, van Dieën JH. Mediolateral foot placement control can be trained: Older adults learn to walk more stable, when ankle moments are constrained. PLoS One 2023; 18:e0292449. [PMID: 37910445 PMCID: PMC10619794 DOI: 10.1371/journal.pone.0292449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
Falls are a problem, especially for older adults. Placing our feet accurately relative to the center-of-mass helps us to prevent falling during gait. The degree of foot placement control with respect to the center-of mass kinematic state is decreased in older as compared to young adults. Here, we attempted to train mediolateral foot placement control in healthy older adults. Ten older adults trained by walking on shoes with a narrow ridge underneath (LesSchuh), restricting mediolateral center-of-pressure shifts. As a training effect, we expected improved foot placement control during normal walking. A training session consisted of a normal walking condition, followed by a training condition on LesSchuh and finally an after-effect condition. Participants performed six of such training sessions, spread across three weeks. As a control, before the first training session, we included two similar sessions, but on normal shoes only. We evaluated whether a training effect was observed across sessions and weeks in a repeated-measures design. Whilst walking with LesSchuh, the magnitude of foot placement error reduced half-a-millimeter between sessions within a week (cohen's d = 0.394). As a training effect in normal walking, the magnitude of foot placement errors was significantly lower compared to the control week, by one millimeter in weeks 2 (cohen's d = 0.686) and 3 (cohen's d = 0.780) and by two millimeters in week 4 (cohen's d = 0.875). Local dynamic stability of normal walking also improved significantly. More precise foot placement may thus have led to improved stability. It remains to be determined whether the training effects were the result of walking on LesSchuh or from repeated treadmill walking itself. Moreover, enhancement of mechanisms beyond the scope of our outcome measures may have improved stability. At the retention test, gait stability returned to similar levels as in the control week. Yet, a reduction in foot placement error persisted.
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Affiliation(s)
- Mohammadreza Mahaki
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
| | - Anina Moira van Leeuwen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
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de Jong LAF, Kerkum YL, Altmann VC, Geurts ACH, Keijsers NLW. Orthopedic footwear has a positive influence on gait adaptability in individuals with hereditary motor and sensory neuropathy. Gait Posture 2023; 106:18-22. [PMID: 37639960 DOI: 10.1016/j.gaitpost.2023.08.011] [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: 09/16/2022] [Revised: 01/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individuals with Hereditary Motor and Sensory Neuropathy (HMSN) are commonly provided with orthopedic footwear to improve gait. Although orthopedic footwear has shown to improve walking speed and spatiotemporal parameters, its effect on gait adaptability has not been established. RESEARCH QUESTION What is the effect of orthopedic footwear on gait adaptability in individuals with HMSN? METHODS Fifteen individuals with HMSN performed a precision stepping task on an instrumented treadmill projecting visual targets, while wearing either custom-made orthopedic or standardized footwear (i.e. minimally supportive, flexible sneakers). Primary measure of gait adaptability was the absolute Euclidean distance [mm] between the target center and the middle of the foot (absolute error). Secondary outcomes included the relative and variable error [mm] in both anterior-posterior (AP) and medial-lateral (ML) directions. Dynamic balance was assessed by the prediction of ML foot placement based on the ML center of mass position and velocity, using linear regression. Dynamic balance was primarily determined by foot placement deviation in terms of root mean square error. Another aspect of dynamic balance was foot placement adherence in terms of the coefficient of determination (R2). Differences between the footwear conditions were analyzed with a paired t-test or Wilcoxon signed-rank test (α = 0.05). RESULTS The absolute error, relative error (AP) and variable error (AP and ML) decreased with orthopedic footwear, whereas the relative error in ML-direction slightly increased. As for dynamic balance, no effect on foot placement deviation or adherence was found. SIGNIFICANCE Gait adaptability improved with orthopedic compared to standardized footwear in people with HMSN, as indicated by improved precision stepping. Dynamic balance, as a possible underlying mechanism, was not affected by orthopedic footwear.
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Affiliation(s)
- Lysanne A F de Jong
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Research and Development, OIM Orthopedie, Assen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Yvette L Kerkum
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Viola C Altmann
- Klimmendaal Revalidatie Specialisten, Arnhem, the Netherlands; Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Noel L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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Effects of vestibular stimulation on gait stability when walking at different step widths. Exp Brain Res 2023; 241:49-58. [PMID: 36346447 DOI: 10.1007/s00221-022-06488-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Vestibular information modulates muscle activity during gait, presumably to contribute to stability. If this is the case, stronger effects of perturbing vestibular information on local dynamic stability of gait, a measure of the locomotor system's response to small, naturally occurring perturbations, can be expected for narrow-base walking (which needs more control) than for normal walking and smaller effects for wide-base walking (which needs less control). An important mechanism to stabilize gait is to coordinate foot placement to center of mass (CoM) state. Vestibular information most likely contributes to sensing this CoM state. We, therefore, expected that stochastic electrical vestibular stimulation (EVS) would decrease the correlation between foot placement and CoM state during the preceding swing phase. In 14 healthy participants, we measured the kinematics of the trunk (as a proxy of the CoM), and feet, while they walked on a treadmill in six conditions: control (usual step width), narrow-base, and wide-base, each with and without stochastic EVS (peak amplitude of 5 mA; RMS of ~ 1.2 mA; frequency band from 0 to 25 Hz). Stochastic EVS decreased local dynamic stability irrespective of step width. Foot placement correlated stronger with trunk motion during walking with EVS than without in the control condition. However, residual variance in foot placement was increased when walking with EVS, indicating less precise foot placement. Thus, a vestibular error signal leads to a decrease in gait stability and precision of foot placement, but these effects are not consistently modulated by step width.
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Zwijgers E, van Asseldonk EHF, Vos-van der Hulst M, Geurts ACH, Keijsers NLW. Impaired foot placement strategy during walking in people with incomplete spinal cord injury. J Neuroeng Rehabil 2022; 19:134. [PMID: 36471441 PMCID: PMC9720963 DOI: 10.1186/s12984-022-01117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Impaired balance during walking is a common problem in people with incomplete spinal cord injury (iSCI). To improve walking capacity, it is crucial to characterize balance control and how it is affected in this population. The foot placement strategy, a dominant mechanism to maintain balance in the mediolateral (ML) direction during walking, can be affected in people with iSCI due to impaired sensorimotor control. This study aimed to determine if the ML foot placement strategy is impaired in people with iSCI compared to healthy controls. METHODS People with iSCI (n = 28) and healthy controls (n = 19) performed a two-minute walk test at a self-paced walking speed on an instrumented treadmill. Healthy controls performed one extra test at a fixed speed set at 50% of their preferred speed. To study the foot placement strategy of a participant, linear regression was used to predict the ML foot placement based on the ML center of mass position and velocity. The accuracy of the foot placement strategy was evaluated by the root mean square error between the predicted and actual foot placements and was referred to as foot placement deviation. Independent t-tests were performed to compare foot placement deviation of people with iSCI versus healthy controls walking at two different walking speeds. RESULTS Foot placement deviation was significantly higher in people with iSCI compared to healthy controls independent of walking speed. Participants with iSCI walking in the self-paced condition exhibited 0.40 cm (51%) and 0.33 cm (38%) higher foot placement deviation compared to healthy controls walking in the self-paced and the fixed-speed 50% condition, respectively. CONCLUSIONS Higher foot placement deviation in people with iSCI indicates an impaired ML foot placement strategy in individuals with iSCI compared to healthy controls.
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Affiliation(s)
- Eline Zwijgers
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Edwin H. F. van Asseldonk
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Marije Vos-van der Hulst
- grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands ,grid.5590.90000000122931605Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Hos M, van Iersel L, van Leeuwen A, Bruijn S. Differential effects of ankle constraints on foot placement control between normal and split belt treadmills. J Biomech 2022; 144:111349. [DOI: 10.1016/j.jbiomech.2022.111349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
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van den Bogaart M, Bruijn SM, Spildooren J, van Dieën JH, Meyns P. The effect of constraining mediolateral ankle moments and foot placement on the use of the counter-rotation mechanism during walking. J Biomech 2022; 136:111073. [DOI: 10.1016/j.jbiomech.2022.111073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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