Proprioceptive perturbations of stability during gait

Balance Adaptation While Standing on a Compliant Base Depends on the Current Sensory Condition in Healthy Young Adults

Background

Several investigations have addressed the process of balance adaptation to external perturbations. The adaptation during unperturbed stance has received little attention. Further, whether the current sensory conditions affect the adaptation rate has not been established. We have addressed the role of vision and haptic feedback on adaptation while standing on foam.

Methods

In 22 young subjects, the analysis of geometric (path length and sway area) and spectral variables (median frequency and mean level of both total spectrum and selected frequency windows) of the oscillation of the centre of feet pressure (CoP) identified the effects of vision, light-touch (LT) or both in the anteroposterior (AP) and mediolateral (ML) direction over 8 consecutive 90 s standing trials.

Results

Adaptation was obvious without vision (eyes closed; EC) and tenuous with vision (eyes open; EO). With trial repetition, path length and median frequency diminished with EC (p < 0.001) while sway area and mean level of the spectrum increased (p < 0.001). The low- and high-frequency range of the spectrum increased and decreased in AP and ML directions, respectively. Touch compared to no-touch enhanced the rate of increase of the low-frequency power (p < 0.05). Spectral differences in distinct sensory conditions persisted after adaptation.

Conclusion

Balance adaptation occurs during standing on foam. Adaptation leads to a progressive increase in the amplitude of the lowest frequencies of the spectrum and a concurrent decrease in the high-frequency range. Within this common behaviour, touch adds to its stabilising action a modest effect on the adaptation rate. Stabilisation is improved by favouring slow oscillations at the expense of sway minimisation. These findings are preliminary to investigations of balance problems in persons with sensory deficits, ageing, and peripheral or central nervous lesion.

Reducing the foot trajectory variabilities during walking through vibratory stimulation of the plantar surface of the foot

Variabilities or fluctuations in foot clearance are considered as a risk factor for falls during walking in older adults. The present study aimed to investigate whether the foot trajectory variability can be reduced by applying vibratory stimulation to the foot's plantar surface during walking. Ten healthy adults were asked to walk on a treadmill with vibratory shoes, and body kinematics were measured. Changes in the mean absolute deviations of the foot trajectory and joint and trunk angles were compared between the periods of applied or absent vibratory stimulus. Our results demonstrated that toe trajectory variability in the swing phase was significantly smaller when a vibratory stimulus was applied. Applying vibratory stimulus to the soles of the forefoot could potentially be used to reduce foot trajectory variability, which could reduce the risk of trips and associated falls during walking in older adults.

A fair and EMG-validated comparison of recruitment criteria, musculotendon models and muscle coordination strategies, for the inverse-dynamics based optimization of muscle forces during gait

Experimental studies and EMG collections suggest that a specific strategy of muscle coordination is chosen by the central nervous system to perform a given motor task. A popular mathematical approach for solving the muscle recruitment problem is optimization. Optimization-based methods minimize or maximize some criterion (objective function or cost function) which reflects the mechanism used by the central nervous system to recruit muscles for the movement considered. The proper cost function is not known a priori, so the adequacy of the chosen function must be validated according to the obtained results. In addition of the many criteria proposed, several physiological representations of the musculotendon actuator dynamics (that prescribe constraints for the forces) along with different musculoskeletal models can be found in the literature, which hinders the selection of the best neuromusculotendon model for each application. Seeking to provide a fair base for comparison, this study measures the efficiency and accuracy of: (i) four different criteria within the static optimization approach (where the physiological character of the muscle, which affects the constraints of the forces, is not considered); (ii) three physiological representations of the musculotendon actuator dynamics: activation dynamics with elastic tendon, simplified activation dynamics with rigid tendon and rigid tendon without activation dynamics; (iii) a synergy-based method; all of them within the framework of inverse-dynamics based optimization. Motion/force/EMG gait analyses were performed on ten healthy subjects. A musculoskeletal model of the right leg actuated by 43 Hill-type muscles was scaled to each subject and used to calculate joint moments, musculotendon kinematics and moment arms. Muscle activations were then estimated using the different approaches, and these estimates were compared with EMG measurements. Although no significant differences were obtained with all the methods at statistical level, it must be pointed out that a higher complexity of the method does not guarantee better results, as the best correlations with experimental values were obtained with two simplified approaches: the static optimization and the physiological approach with simplified activation dynamics and rigid tendon, both using the sum of the squares of muscle forces as objective function.

Lower-limb muscle responses evoked with noisy vibrotactile foot sole stimulation

AIM

Cutaneous feedback from the foot sole contributes to the control of standing balance in two ways: it provides perceptual awareness of tactile perturbations at the interface with the ground (e.g., shifts in the pressure distribution, slips, etc.) and it reflexively activates lower-motor neurons to trigger stabilizing postural responses. Here we focus on the latter, cutaneous (or cutaneomotor) reflex coupling in the lower limb. These reflexes have been studied most-frequently with electrical pulse trains that bypass natural cutaneous mechanotransduction, stimulating cutaneous afferents in a largely non-physiological manner. Harnessing the mechanical filtering properties of cutaneous afferents, we take a novel mechanical approach by applying supra-threshold continuous noisy vibrotactile stimulation (NVS) to the medial forefoot.

METHODS

Using NVS, we characterized the time and frequency domain properties of cutaneomotor reflexes in the Tibialis Anterior. We additionally measured stimulus-triggered average muscle responses to repeated discrete sinusoidal pulses for comparison. To investigate cutaneomotor reflex gain scaling, stimuli were delivered at 3- or 10-times perceptual threshold (PT), while participants held 12.5% or 25% of maximum voluntary contraction (MVC).

RESULTS

Peak responses in the time domain were observed at lags reflecting transmission delay through a polysynaptic reflex pathway (~90-100 ms). Increasing the stimulus amplitude enhanced cutaneomotor coupling, likely by increasing afferent firing rates. Although greater background muscle contraction increased the overall amplitude of the evoked responses, it did not increase the proportion of the muscle response attributable to cutaneous input.

CONCLUSION

Taken together, our findings support the use of NVS as a novel tool for probing the physiological properties of cutaneomotor reflex pathways.

Balance Training Enhances Motor Coordination During a Perturbed Sidestep Cutting Task

Study Design Controlled laboratory study. Background Balance training may improve motor coordination. However, little is known about the changes in motor coordination during unexpected perturbations to postural control following balance training. Objectives To study the effects of balance training on motor coordination and knee mechanics during perturbed sidestep cutting maneuvers in healthy adults. Methods Twenty-six healthy men were randomly assigned to a training group or a control group. Before balance training, subjects performed unperturbed, 90° sidestep cutting maneuvers and 1 unexpected perturbed cut (10-cm translation of a movable platform). Participants in the training group participated in a 6-week balance training program, while those in the control group followed their regular activity schedule. Both groups were retested after a 6-week period. Surface electromyography was recorded from 16 muscles of the supporting limb and trunk, as well as kinematics and ground reaction forces. Motor modules were extracted from electromyography by nonnegative matrix factorization. External knee abduction moments were calculated using inverse dynamics equations. Results Balance training reduced the external knee abduction moment (33% ± 25%, P<.03, η_p² = 0.725) and increased the activation of trunk and proximal hip muscles in specific motor modules during perturbed cutting. Balance training also increased burst duration for the motor module related to landing early in the perturbation phase (23% ± 11%, P<.01, η_p² = 0.532). Conclusion Balance training resulted in altered motor coordination and a reduction in knee abduction moment during an unexpected perturbation. The previously reported reduction in injury incidence following balance training may be linked to changes in dynamic postural stability and modular neuromuscular control. J Orthop Sports Phys Ther 2017;47(11):853-862. Epub 23 Sep 2017. doi:10.2519/jospt.2017.6980.

Losing touch: age-related changes in plantar skin sensitivity, lower limb cutaneous reflex strength, and postural stability in older adults

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age and may predict postural instability; however, alteration in lower limb cutaneous reflex strength may also explain greater instability in older adults and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 and 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30- and 250-Hz vibration to drive mechanically evoked reflex responses in the tibialis anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography in subjects during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30-Hz vibration, cutaneous reflexes were observed in 95% of young adults but in only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250-Hz vibration, suggesting this high-frequency cutaneous input is filtered out by motoneurons innervating tibialis anterior. Our findings have important implications for assessing the risk of balance impairment in older adults.

Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson's disease

New treatments based on peripheral stimulation of the sensory–motor system have been inspiring new rehabilitation approaches in Parkinson’s disease (PD), especially to reduce gait impairment, levodopa washout effects, and the incidence of falls. The aim of this study was to evaluate the change in gait and the clinical status of PD patients after six sessions of a treatment based on automated mechanical peripheral stimulation (AMPS). Eighteen patients with PD and 15 age-matched healthy individuals (control group) participated in this study. A dedicated medical device delivered the AMPS. PD patients were treated with AMPS six times once every 4 days. All PD patients were treated in the off-levodopa phase and were evaluated with gait analysis before and after the first intervention (acute phase), after the sixth intervention, 48 h after the sixth intervention, and 10 days after the end of the treatment. To compare the differences among the AMPS interventions (pre, 6 AMPS, and 10 days) in terms of clinical scales, a t-test was used (α≤0.05). In addition, to compare the differences among the AMPS interventions (pre, post, 6 AMPS, 48 h and 10 days), the gait spatiotemporal parameters were analyzed using the Friedman test and the Bonferroni post-hoc test (α≤0.05). Also, for comparisons between the PD group and the control group, the gait spatiotemporal parameters were analyzed using the Mann–Whitney test and the Bonferroni post-hoc test (α≤0.05). The results of the study indicate that the AMPS treatment has a positive effect on bradykinesia because it improves walking velocity, has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. These results are consistent with the improvements measured with clinical scales. These findings indicate that AMPS treatment seems to generate a more stable walking pattern in PD patients, reducing the well-known gait impairment that is typical of PD; regular repetition every 4 days of AMPS treatment appears to be able to improve gait parameters, to restore rhythmicity, and to reduce the risk of falls, with benefits maintained up to 10 days after the last treatment. The trial was registered online at ClinicalTrials.gov (number identifier: NCT0181528).

Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase

Background

Recovering from trips is challenging for transfemoral amputees, and attempts often result in falls. Better understanding of the effects of the sensory-motor deficits brought by amputation and the functional limitations of prosthetic devices could help guide therapy and fall prevention mechanisms in prostheses. However, how transfemoral amputees attempt to recover from trips on the sound and prosthesis sides throughout swing phase is poorly understood.

Methods

We tripped eight able-bodied subjects and eight unilateral transfemoral amputees wearing their prescribed prostheses. The protocol consisted of six repetitions of 6 and 4 points throughout swing phase, respectively. We compared recovery strategies in able-bodied, sound side and prosthesis side limbs. The number of kinematic recovery strategies used, when they were used throughout swing phase, and kinematic characteristics (tripped limb joint angles, bilateral trochanter height and time from foot arrest to foot strike) of each strategy were compared across limb groups. Non-parametric statistical tests with corrections for post-hoc tests were used.

Results

Amputees used the same recovery strategies as able-bodied subjects on both sound and prosthesis sides, although not all subjects used all strategies. Compared to able-bodied subjects, amputees used delayed-lowering strategies less often from 30-60 % of swing phase on the sound side, and from 45-60 % of swing phase on the prosthesis side. Within-strategy kinematic differences occurred across limbs; however, these differences were not consistent across all strategies. Amputee-specific recovery strategies—that are not used by control subjects—occurred following trips on both the sound and prosthesis sides in mid- to late swing.

Conclusions

Collectively, these results suggest that sensory input from the distal tripped leg is not necessary to trigger able-bodied trip recovery strategies. In addition, the differences between sound and prosthesis side recoveries indicate that the ability of the support leg might be more critical than that of the tripped leg when determining the response to a trip. The outcomes of this study have implications for prosthesis control, suggesting that providing correct and intuitive real-time selection of typical able-bodied recovery strategies by a prosthetic device when it is the tripped and the support limb could better enable balance recovery and avoid falls.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-015-0067-8) contains supplementary material, which is available to authorized users.

Effects of the site and extent of plantar cutaneous stimulation on dynamic balance and muscle activity while walking

BACKGROUND

Previous studies have demonstrated that stimulating the cutaneous plantar sensory receptors of the foot through textured insoles improves human balance and walking. This study investigated the effect of medial and lateral zoned textured insoles using tibialis anterior/peroneus longus surface electromyographic activity and Centre-of-Pressure as indicators of postural stability while walking.

METHODS

15 asymptomatic subjects were tested using a within-subject randomised repeated measures design. The effect of lateral and medial zoned insoles of varying heights (control, 2, 4 and 6mm) on stability while walking under normal and impaired visual conditions was assessed.

RESULTS

Impaired vision resulted in an increase in foot CoP variability while walking (p<0.05). The laterally zoned insole was associated with a significant (repeated measures ANOVA p<0.05) increase in the rate of medial-lateral CoP change.

CONCLUSION

These findings suggest that the site of stimulation of the plantar foot cutaneous receptors may increase postural instability during walking. This should be considered in the design of insoles that aim to improve balance and reduce falls risk. The importance of vision in balance control has been highlighted and using impaired vision may serve as a way of trialling clinical products in the healthy population.

Triceps surae fascicle stretch is poorly correlated with short latency stretch reflex size

INTRODUCTION

The short latency stretch reflex (SLR) is well described, but the stimulus that evokes the SLR remains elusive. One hypothesis states that reflex size is proportional to muscle fiber stretch, so in this study we examined the relationship between these 2 parameters in human triceps surae muscles.

METHODS

Achilles tendon taps and dorsiflexion stretches with different amplitudes and preactivation torques were applied to 6 participants while electromyography and muscle fascicle length changes were recorded in soleus and medial gastrocnemius (MG).

RESULTS

In response to tendon taps, neither fascicle length nor velocity changes were correlated with SLR size in either muscle, but accelerometer peaks were observed immediately after hammer-tendon contact. Similar results were obtained after dorsiflexion stretches.

CONCLUSION

Muscle fascicle stretch is poorly correlated with SLR size, regardless of perturbation parameters. We attribute the SLR trigger to the transmission of vibration through the lower limb, rather than muscle fiber stretch.

Allocation of Attentional Resources toward a Secondary Cognitive Task Leads to Compromised Ankle Proprioceptive Performance in Healthy Young Adults

The objective of the present study was to determine whether increased attentional demands influence the assessment of ankle joint proprioceptive ability in young adults. We used a dual-task condition, in which participants performed an ankle ipsilateral position-matching task with and without a secondary serial auditory subtraction task during target angle encoding. Two experiments were performed with two different cohorts: one in which the auditory subtraction task was easy (experiment 1a) and one in which it was difficult (experiment 1b). The results showed that, compared with the single-task condition, participants had higher absolute error under dual-task conditions in experiment 1b. The reduction in position-matching accuracy with an attentionally demanding cognitive task suggests that allocation of attentional resources toward a difficult second task can lead to compromised ankle proprioceptive performance. Therefore, these findings indicate that the difficulty level of the cognitive task might be the possible critical factor that decreased accuracy of position-matching task. We conclude that increased attentional demand with difficult cognitive task does influence the assessment of ankle joint proprioceptive ability in young adults when measured using an ankle ipsilateral position-matching task.

Age-related neuromuscular function and dynamic balance control during slow and fast balance perturbations

This study investigated age-related differences in dynamic balance control and its connection to reflexes and explosive isometric plantar flexor torque in 19 males (9 Young aged 20–33 yr, 10 Elderly aged 61–72 yr). Dynamic balance was measured during Slow (15 cm/s) and Fast (25 cm/s) anterior and posterior perturbations. H/M-ratio was measured at 20% of maximal M-wave (H/M20%) 10, 30, and 90 ms after perturbations. Stretch reflexes were measured from tibialis anterior and soleus during anterior and posterior perturbations, respectively. In Slow, Elderly exhibited larger peak center-of-pressure (COP) displacement (15%; P < 0.05) during anterior perturbations. In Fast, Young showed a trend for faster recovery (37%; P = 0.086) after anterior perturbations. M-wave latency was similar between groups (6.2 ± 0.7 vs. 6.9 ± 1.2 ms), whereas Elderly showed a longer H-reflex latency (33.7 ± 2.3 vs. 36.4 ± 1.7 ms; P < 0.01). H/M20% was higher in Young 30 ms after Fast anterior (50%; P < 0.05) and posterior (51%; P < 0.05) perturbations. Plantar flexor rapid torque was also higher in Young (26%; P < 0.05). After combining both groups' data, H/M20% correlated negatively with Slow peak COP displacement ( r = −0.510, P < 0.05) and positively with Fast recovery time ( r = 0.580, P < 0.05) for anterior perturbations. Age-related differences in balance control seem to be more evident in anterior than posterior perturbations, and rapid sensory feedback is generally important for balance perturbation recovery.

Unilateral balance training enhances neuromuscular reactions to perturbations in the trained and contralateral limb

The aim of this study was to investigate the effect of unilateral balance training on the reactive recovery of balance for both trained and untrained limbs. Twenty-three subjects were randomly assigned to either a control group (CG) or a training group (TG). The latter performed six weeks of balance training for the right leg. The pre- and post-training measurements were based on single leg standing posture on a moveable force platform which moved 6 cm anteriorly. TG subjects were tested on the trained (TR) and untrained leg (UTR), whereas CG subjects were tested on the right leg (CTR). The center of pressure trajectory length (CPLEN) and average speed (CPSPD) as well as onsets of muscular activation and time to peak (EMGTP) from lower limb muscles were calculated and compared by a 2-way ANOVA (three legs×two training status). Muscular onsets were reduced after training for TR (∼19 ms, p<0.05) and UTR (∼17 ms, p<0.05) with no significant changes for CTR. No effects of training for CPLEN and medial-lateral CPSPD were found. Furthermore, the EMGTP of UTR was predominantly greater before training (∼17 ms, p<0.05). However, after training the EMGTP was similar among limbs. These results suggest that concomitant with improved balance recovery and neuromuscular reactions in TR, there is also a cross-education effect in UTR, which might be predominantly related to supraspinal adaptations shared between interconnected structures in the brain.

Effects of mechanical vibration of the foot sole and ankle tendons on cutaneomuscular responses in man

The modulation of cutaneomuscular responses in response to mechanical vibration applied to the foot sole and to the ankle tendons was established in ten healthy subjects. The effects of mechanical vibration applied to the skin adjacent to the tibialis anterior (TA) and Achilles tendons were examined in two subjects. With the subjects seated, mechanical vibration applied to the TA and/or Achilles tendons significantly depressed the cutaneomuscular responses in all subjects, regardless of the frequency (50, 150, 250 Hz) of vibration. Mechanical vibration applied either to the foot sole or to the skin adjacent to the tendons induced no significant effects. The demonstration that mechanical vibration applied to muscle tendons exerts an inhibitory effect on cutaneomuscular responses supports the hypothesis that receptors that mediate body kinesthesia can be used as a vehicle to alter the spinal excitability state. The data suggests that tendon vibration could be utilized in neurological disorders to induce exogenous-mediated potentiation of presynaptic inhibition.

Hip proprioceptors preferentially modulate reflexes of the leg in human spinal cord injury

Stretch-sensitive afferent feedback from hip muscles has been shown to trigger long-lasting, multijoint reflex responses in people with chronic spinal cord injury (SCI). These reflexes could have important implications for control of leg movements during functional activities, such as walking. Because the control of leg movement relies on reflex regulation at all joints of the limb, we sought to determine whether stretch of hip muscles modulates reflex activity at the knee and ankle and, conversely, whether knee and ankle stretch afferents affect hip-triggered reflexes. A custom-built servomotor apparatus was used to stretch the hip muscles in nine chronic SCI subjects by oscillating the legs about the hip joint bilaterally from 10° of extension to 40° flexion. To test whether stretch-related feedback from the knee or ankle would be affected by hip movement, patellar tendon percussions and Achilles tendon vibration were delivered when the hip was either extending or flexing. Surface electromyograms (EMGs) and joint torques were recorded from both legs. Patellar tendon percussions and Achilles tendon vibration both elicited reflex responses local to the knee or ankle, respectively, and did not influence reflex responses observed at the hip. Rather, the movement direction of the hip modulated the reflex responses local to the joint. The patellar tendon reflex amplitude was larger when the perturbation was delivered during hip extension compared with hip flexion. The response to Achilles vibration was modulated by hip movement, with an increased tonic component during hip flexion compared with extension. These results demonstrate that hip-mediated sensory signals modulate activity in distal muscles of the leg and appear to play a unique role in modulation of spastic muscle activity throughout the leg in SCI.

The effect of limb crossing and limb congruency on multisensory integration in peripersonal space for the upper and lower extremities

The present study investigated how multisensory integration in peripersonal space is modulated by limb posture (i.e. whether the limbs are crossed or uncrossed) and limb congruency (i.e. whether the observed body part matches the actual position of one's limb). This was done separately for the upper limbs (Experiment 1) and the lower limbs (Experiment 2). The crossmodal congruency task was used to measure peripersonal space integration for the hands and the feet. It was found that the peripersonal space representation for the hands but not for the feet is dynamically updated based on both limb posture and limb congruency. Together these findings show how dynamic cues from vision, proprioception, and touch are integrated in peripersonal limb space and highlight fundamental differences in the way in which peripersonal space is represented for the upper and lower extremity.

Effects of perturbations to balance on neuromechanics of fast changes in direction during locomotion

This study investigated whether the modular control of changes in direction while running is influenced by perturbations to balance. Twenty-two healthy men performed 90° side-step unperturbed cutting manoeuvres while running (UPT) as well as manoeuvres perturbed at initial contact (PTB, 10 cm translation of a moveable force platform). Surface EMG activity from 16 muscles of the supporting limb and trunk, kinematics, and ground reaction forces were recorded. Motor modules composed by muscle weightings and their respective activation signals were extracted from the EMG signals by non-negative matrix factorization. Knee joint moments, co-contraction ratios and co-contraction indexes (hamstrings/quadriceps) and motor modules were compared between UPT and PTB. Five motor modules were enough to reconstruct UPT and PTB EMG activity (variance accounted for UPT  = 92±5%, PTB = 90±6%). Moreover, higher similarities between muscle weightings from UPT and PTB (similarity = 0.83±0.08) were observed in comparison to the similarities between the activation signals that drive the temporal properties of the motor modules (similarity = 0.71±0.18). In addition, the reconstruction of PTB EMG from fixed muscle weightings from UPT resulted in higher reconstruction quality (82±6%) when compared to reconstruction of PTB EMG from fixed activation signals from UPT (59±11%). Perturbations at initial contact reduced knee abduction moments (7%), as well as co-contraction ratio (11%) and co-contraction index (12%) shortly after the perturbation onset. These changes in co-contraction ratio and co-contraction index were caused by a reduced activation of hamstrings that was also verified in the activation signals of the specific motor module related to initial contact. Our results suggested that perturbations to balance influence modular control of cutting manoeuvres, especially the temporal properties of muscle recruitment, due to altered afferent inputs to the motor patterns. Furthermore, reduced knee stability during perturbed events may be related to overall control of lower limb muscles.

Modular organization of balance control following perturbations during walking

Balance recovery during walking requires complex sensory-motor integration. Mechanisms to avoid falls are active concomitantly with human locomotion motor patterns. It has been suggested that gait can be described by a set of motor modules (synergies), but little is known on the modularity of gait during recovery of balance due to unexpected slips. Our hypothesis was that muscular activation during reactive recovery of balance during gait has a modular organization. The aim of the study was to verify this hypothesis when perturbations were delivered in different directions. Eight healthy men walked on a 7-m walkway, which had a moveable force platform embedded in the middle. Subjects experienced unperturbed walking as well as perturbations delivered in the sagittal (forward and backward) and frontal (leftward and rightward) planes. Bilateral full-body kinematics and surface electromyography (EMG) from lower limbs, trunk, and neck were recorded during walking. Synergies and activation signals were extracted from surface EMG signals. Four modules were sufficient to explain the unperturbed gait and the gait perturbed in any of the perturbation directions. Moreover, three of four modules extracted from the unperturbed gait were the same for gait perturbed forward, leftward, and rightward (similarity in synergies = 0.94 ± 0.03). On the other hand, the activation signals were different between unperturbed and perturbed gait (average correlation coefficient = 0.55 ± 0.16). These strategies to recover balance were robust across subjects. In conclusion, changes in lower limb and trunk kinematics provoked by perturbations were reflected in minimal adjustments in the muscular modular organization of walking, with three of four modules preserved from normal walking. Conversely, the activation signals were all substantially influenced by the perturbations, being the result of integration of afferent information and supraspinal control.

Biomechanical strategies to accommodate expected slips in different directions during walking

The aim of the study was to verify whether heel kinematics, ground reaction forces and electromyography (EMG) during walking are affected when anticipating slips in anterior-posterior (AP) and medial-lateral directions (ML). Eight healthy men walked through a 7-m walkway, stepping on a robotic force platform. Initially, baseline (BASE) gait mechanics were assessed with the platform at rest. Subsequently, two sets of randomized perturbations (10-cm translations with at different platform movement velocities) in the AP and ML direction were applied. Perturbations were interspersed with unperturbed walking (i.e., catch-trials C-AP and C-ML). Heel accelerations, ground reaction forces and activities from the perturbed leg and trunk muscles were analyzed. EMG was analysed in four epochs: PRE (-100 ms to heel strike [HS]), EARLY (HS to 150 ms after HS), MID (150-300 ms after HS) and LATE (300 ms to toe-off). Comparisons were made between BASE, C-AP and C-ML. The first peak of the vertical force component (Fz) was decreased for C-AP and C-ML (p<0.05) but no changes were found for braking and propulsion impulses. EMG showed effects of expected slips on tibialis anterior, gastrocnemius lateralis, soleus and peroneus longus, especially for EARLY and MID epochs, with direction-specific increases in activity. In conclusion, expected slips in different directions determine only marginal changes in terms of kinetics and heel kinematics, but selective activation after HS indicates that direction-dependent strategies are adopted when anticipating perturbations.

Vibration-induced motor responses of infants with and without myelomeningocele

BACKGROUND

The severity of myelomeningocele (MMC) stems both from a loss of neurons due to neural tube defect and a loss of function in viable neurons due to reduced movement experience during the first year after birth. In young infants with MMC, the challenge is to reinforce excitability and voluntary control of all available neurons. Muscle vibration paired with voluntary movement may increase motoneuron excitability and contribute to improvements in neural organization, responsiveness, and control.

OBJECTIVES

This study examined whether infants with or without MMC respond to vibration by altering their step or stance behavior when supported upright on a treadmill.

DESIGN

This was a cross-sectional study.

METHODS

Twenty-four 2- to 10-month-old infants, 12 with typical development (TD) and 12 with MMC (lumbar and sacral lesions), were tested. Infants were supported upright with their feet in contact with a stationary or moving treadmill during 30-second trials. Rhythmic alternating vibrations were applied to the right and left rectus femoris muscles, the lateral gastrocnemius muscle, or the sole of the foot. Two cameras and behavior coding were used to determine step count, step type, and motor response to vibration onset.

RESULTS

Step count decreased and swing duration increased in infants with TD during vibration of the sole of the foot on a moving treadmill (FT-M trials). Across all groups the percentage of single steps increased during vibration of the lateral gastrocnemius muscle on a moving treadmill. Infants with MMC and younger infants with TD responded to onset of vibration with leg straightening during rectus femoris muscle stimulation and by stepping during FT-M trials more often than older infants with TD.

CONCLUSIONS

Vibration seems a viable option for increasing motor responsiveness in infants with MMC. Follow-up studies are needed to identify optimal methods of administering vibration to maximize step and stance behavior in infants.

Barefoot running claims and controversies: a review of the literature

BACKGROUND

Barefoot running is slowly gaining a dedicated following. Proponents of barefoot running claim many benefits, such as improved performance and reduced injuries, whereas detractors warn of the imminent risks involved.

METHODS

Multiple publications were reviewed using key words.

RESULTS

A review of the literature uncovered many studies that have looked at the barefoot condition and found notable differences in gait and other parameters. These findings, along with much anecdotal information, can lead one to extrapolate that barefoot runners should have fewer injuries, better performance, or both. Several athletic shoe companies have designed running shoes that attempt to mimic the barefoot condition and, thus, garner the purported benefits of barefoot running.

CONCLUSIONS

Although there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches who understand and can minimize the risks.

Triceps surae short latency stretch reflexes contribute to ankle stiffness regulation during human running

During human running, short latency stretch reflexes (SLRs) are elicited in the triceps surae muscles, but the function of these responses is still a matter of controversy. As the SLR is primarily mediated by Ia afferent nerve fibres, various methods have been used to examine SLR function by selectively blocking the Ia pathway in seated, standing and walking paradigms, but stretch reflex function has not been examined in detail during running. The purpose of this study was to examine triceps surae SLR function at different running speeds using Achilles tendon vibration to modify SLR size. Ten healthy participants ran on an instrumented treadmill at speeds between 7 and 15 km/h under 2 Achilles tendon vibration conditions: no vibration and 90 Hz vibration. Surface EMG from the triceps surae and tibialis anterior muscles, and 3D lower limb kinematics and ground reaction forces were simultaneously collected. In response to vibration, the SLR was depressed in the triceps surae muscles at all speeds. This coincided with short-lasting yielding at the ankle joint at speeds between 7 and 12 km/h, suggesting that the SLR contributes to muscle stiffness regulation by minimising ankle yielding during the early contact phase of running. Furthermore, at the fastest speed of 15 km/h, the SLR was still depressed by vibration in all muscles but yielding was no longer evident. This finding suggests that the SLR has greater functional importance at slow to intermediate running speeds than at faster speeds.

Balance responses to lateral perturbations in human treadmill walking

During walking on a treadmill 10 human subjects (mean age 20 years) were perturbed by 100 ms pushes or pulls to the left or the right, of various magnitudes and in various phases of the gait cycle. Balance was maintained by (1) a stepping strategy (synergy), in which the foot at the next step is positioned a fixed distance outward of the 'extrapolated centre of mass', and (2) a lateral ankle strategy, which comprises a medial or lateral movement of the centre of pressure under the foot sole. The extrapolated centre of mass is defined as the centre of mass position plus the centre of mass velocity multiplied by a parameter related to the subject's leg length. The ankle strategy is the fastest, with a mechanical delay of about 200 ms (20% of a stride), but it can displace the centre of pressure no more than 2 cm. The stepping strategy needs at least 300 ms (30% of a stride) before foot placement, but has a range of 20 cm. When reaction time is sufficient, the magnitude of the total response is in good agreement with our hypothesis: mean centre of pressure (foot) position is a constant distance outward of the extrapolated centre of mass. If the reaction time falls short, a further correction is applied in the next step. In the healthy subjects studied here, no further corrections were necessary, so balance was recovered within two steps (one stride).

Ultrasonography as a tool to study afferent feedback from the muscle-tendon complex during human walking

In humans, one of the most common tasks in everyday life is walking, and sensory afferent feedback from peripheral receptors, particularly the muscle spindles and Golgi tendon organs (GTO), makes an important contribution to the motor control of this task. One factor that can complicate the ability of these receptors to act as length, velocity and force transducers is the complex pattern of interaction between muscle and tendinous tissues, as tendon length is often considerably greater than muscle fibre length in the human lower limb. In essence, changes in muscle-tendon mechanics can influence the firing behaviour of afferent receptors, which may in turn affect the motor control. In this review we first summarise research that has incorporated the use of ultrasound-based techniques to study muscle-tendon interaction, predominantly during walking. We then review recent research that has combined this method with an examination of muscle activation to give a broader insight to neuromuscular interaction during walking. Despite the advances in understanding that these techniques have brought, there is clearly still a need for more direct methods to study both neural and mechanical parameters during human walking in order to unravel the vast complexity of this seemingly simple task.