Task difficulty has no effect on haptic anchoring during tandem walking in young and older adults

Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions

BACKGROUND

Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months.

METHODS

Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20-60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery.

RESULTS

Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy.

CONCLUSION

Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Effect of the haptic anchors during balancing and walking tasks in older adults: A systematic review

BACKGROUND

Older adults are benefited from the continuous tactile information to enhance postural control. Therefore, the aim was to evaluate the effect of the haptic anchors during balancing and walking tasks in older adults.

METHODS

The search strategy (up to January 2023) was based on the PICOT (older adults; anchor system during balance and walking tasks; any control group; postural control measurements; short and/or long-term effect). Two pairs of reviewers independently examined all titles and abstracts for eligibility. The reviewers independently extracted data from the included studies, assessed the risk of bias, and certainty of the evidence.

RESULTS

Six studies were included in the qualitative synthesis. All studies used a 125-g haptic anchor system. Four studies used anchors when standing in a semi-tandem position, two in tandem walking on different surfaces, and one in an upright position after plantar flexor muscle fatigue. Two studies showed that the anchor system reduced body sway. One study showed that the ellipse area was significantly lower for the 50% group (reduced frequency) in the post-practice phase. One study showed that the reduction in the ellipse area was independent of the fatigue condition. Two studies observed reduced trunk acceleration in the frontal plane during tandem waking tasks. The studies had low to moderate certainty of evidence.

CONCLUSION

Haptic anchors can reduce postural sway during balance and walking tasks in older adults. Also, positive effects were seen during the delayed post-practice phase after the removal of anchors only in individuals who used a reduced anchor frequency.

Acute Effects of a Haptic Anchor System on Postural Sway of Individuals with Parkinson's Disease: A Preliminary Study

Some investigators have demonstrated that an anchor system can improve postural control in elderly persons during balance tasks, but none have reported on the use of this approach in individuals with Parkinson's disease (PD). Therefore, we aimed to evaluate the effect of an anchor system on postural sway in elderly individuals with (n = 13) and without (n = 14) PD. In this cross-sectional study, we measured postural sway with a force platform based on the Clinical Test of Sensory Interaction of Balance (CTSIB). We calculated center of pressure (COP) parameters, as a function of time, based on the ellipse sway area (cm²) and evaluated self-efficacy for postural control based on the degree of difficulty in each task. With the anchor system (i.e., handheld ropes attached to weights on the floor), we observed a significant reduction in the ellipse sway area in the semi-tandem position among individuals with PD (p = .04). For participants without PD, there was no significant difference in sway with or without the anchor system in all positions. Also, for participants with PD, there was an improvement in self-efficacy for postural control associated with the anchor system in several positions while there was only a self-efficacy improvement with the anchor system in the semi-tandem position for those without PD. Acute use of a haptic anchor system reduced postural sway in the semi-tandem position in individuals with PD, and the anchor system generally improved postural control self-efficacy for body sway in individuals with PD.

Physical activity does not impact mediolateral margin of stability across a range of postural-perturbing conditions in young adults

BACKGROUND

The maintenance of stability during walking is critical for successful locomotion. While targeted balance training can improve stability, it is unclear how simply meeting recommended physical activity guidelines may impact dynamic stability in healthy young adults.

RESEARCH QUESTION

Examining the differences in the mediolateral margin of stability (ML-MOS) and the variability of the ML-MOS in physically active and inactive young adults across a range of stability-challenging walking tasks METHOD: Twenty-one physically active and twenty inactive young adults completed four experimental walking conditions: (1) Overground Walking, (2) Tandem Walking, (3) Beam Walking, and (4) Stepping-Stones. The ML-MOS and coefficient of variation of the ML-MOS were calculated at each heel strike while participants walked at their preferred walking speed. A two-way mixed-effects ANOVA was conducted to examine the effects of group and condition and their interaction on ML-MOS and ML-MOS variability RESULTS: Neither the ML-MOS nor the variability of the ML-MOS was significantly different between physically active and physically inactive young adults during any experimental walking conditions. A significant main effect of the experimental walking condition was observed, with the ML-MOS decreasing from overground walking to the tandem and beam walking conditions. The ML-MOS also became more variable in the tandem, beam, and stepping-stones conditions than in overground gait.

SIGNIFICANCE

Physical activity status did not influence frontal plane dynamic balance in healthy young adults, even in stability-challenging environments. Conditions that constrain step width, such as tandem and beam walking, are adequate for challenging frontal plane dynamic balance and indicate that trunk kinematics may be adjusted when step width is constrained.

Three days of beam walking practice improves dynamic balance control regardless of the use of haptic anchors in older adults

Balance deficits during walking increase the risk of falls in older adults. Providing haptic information through anchors improves dynamic balance control, but the benefits of practicing with anchors during walking need to be evaluated. We investigated the effect of practice with haptic anchors in the beam walking task in older adults. Twenty-five older adults participated in this study divided into 0% (G0, practice without the anchors) and 50% (G50, practice with the haptic anchors in 50% of the trials) groups. With the anchors, participants held in each hand a cable with a mass of 0.125 kg affixed to the end of the cable that contacted the ground. They walked and kept the anchors in contact with the ground such that they dragged them. Participants increased the distance walked on the beam and reduced the trunk angular acceleration after training, but this effect was independent of the anchors. The use of haptic anchors during beam walking training did not significantly affect older adults' performance and dynamic balance control. Both groups showed improvements in the post-test and 24-hr retention conditions, indicating that older adults can learn to adapt their gait to more challenging contexts.

Beam width and arm position but not cognitive task affect walking balance in older adults

Detection of changes in dynamic balance could help identify older adults at fall risk. Walking on a narrow beam with its width, cognitive load, and arm position manipulated could be an alternative to current tests. Therefore, we examined additive and interactive effects of beam width, cognitive task (CT), and arm position on dynamic balance during beam walking in older adults. Twenty older adults (69 ± 4y) walked on 6, 8, and 10-cm wide beams (2-cm high, 4-m-long), with and without CT, with three arm positions (free, crossed, akimbo). We determined cognitive errors, distance walked, step speed, root mean square (RMS) of center of mass (COM) displacement and trunk acceleration in the frontal plane. Beam width decrease progressively reduced distance walked and increased trunk acceleration RMS. Step speed decreased on the narrowest beam and with CT. Arm crossing decreased distance walked and step speed. COM displacement RMS and cognitive errors were not affected by any manipulation. In conclusion, distance walked indicated that beam width and arm position, but less so CT, affected dynamic balance, implying that beam walking has the potential to become a test of fall risk. Stability measurements suggested effective trunk adjustments to control COM position and keep dynamic balance during the task.

Relations between gait characteristics and subjective visual vertical results in young adults

OBJECTIVE

Subjective visual vertical (SVV) deviation can indicate impairments of motion perception and spatial orientation in individuals with vestibular disorders. This study investigated the influence of SVV on tandem gait ability by assessing differences between temporal, spatial, and kinematic characteristics in young adults.

METHODS

We recruited sixteen young adults with increased SVV and 17 age-matched control subjects. All subjects recruited for this study were with no history of neurological or musculoskeletal diseases. Knee and hip-joint kinematic data, spatio-temporal parameters, and gait variability were measured during tandem gait.

RESULTS

Stride time variability and stride velocity variability were significantly greater in the experimental group than the control group (p < 0.05). In addition, a significant correlation was observed between stride time variability and SVV results (r = 0.345, p < 0.05). However, hip and knee joint angles were non-significantly different in the experimental and control groups (p > 0.05) and spatio-temporal parameters were similar between the two groups (p > 0.05).

CONCLUSION

Stride time variability and stride velocity variability during tandem gait were significantly different in the experimental and control groups. We presume that increased SVV deviation is related to greater gait variability during tandem gait.

Adding Light Touch While Walking in Older Adults: Biomechanical and Neuromotor Effects

Adding haptic input may improve balance control and help prevent falls in older adults. This study examined the effects of added haptic input via light touch on a railing while walking. Participants (N = 53, 75.9 ± 7.9 years) walked normally or in tandem (heel to toe) with and without haptic input. During normal walking, adding haptic input resulted in a more cautious and variable gait pattern, reduced variability of center of mass acceleration and margin of stability, and increased muscle activity. During tandem walking, haptic input had minimal effect on step parameters, decreased lower limb muscle activity, and increased cocontraction at the ankle closest to the railing. Age was correlated with step width variability, stride length variability, stride velocity, variability of medial-lateral center of mass acceleration, and margin of stability for tandem walking. This complex picture of sensorimotor integration in older adults warrants further exploration into added haptic input during walking.

Trunk balance control during beam walking improves with the haptic anchors without the interference of an auditory-cognitive task in older adults

BACKGROUND

Prior studies have shown that older adults reduced trunk acceleration when walking on a balance beam with haptic inputs provided by anchors; however, it is unknown whether these benefits would remain in the presence of a concurrent cognitive task.

RESEARCH QUESTION

This study aimed to evaluate the effect of a cognitive task on balance control when using the anchors while walking on a balance beam in older adults.

METHODS

Thirty older adults participated in this study. They walked on a balance beam under four conditions combining haptic inputs (with and without anchors) and a cognitive task (present and absent). The anchors consisted of a flexible cable with a small load (125 g) attached at the end contacting the ground. Participants held one anchor in each hand and dragged the loads over the ground while walking. In the cognitive task, participants silently counted the number of times they heard a target number within a series of random numbers and provided their response at the end of each trial. Trunk acceleration and normalized step speed were assessed.

RESULTS

The anchors reduced the normalized step speed and the trunk acceleration amplitude in the frontal plane when walking on the beam. The cognitive task also diminished the normalized step speed in the beam walking. The use of the anchors did not influence the cognitive task performance.

SIGNIFICANCE

Even on a balance beam in the presence of a cognitive task, haptic anchors were able to reduce trunk acceleration in older adults to improve balance control. The cognitive task did not affect the use of haptic anchors.

Older adults reduce the complexity and efficiency of neuromuscular control to preserve walking balance

Healthy aging modifies neuromuscular control of dynamic balance. Challenging tasks could amplify such modifications, providing clinical insights. We examined the effects of age and walking condition difficulty on neuromuscular control of walking balance. We analyzed whole-body kinematics and activity of 13 right leg and trunk muscles in 17 young (11 males and 6 females; age 24 ± 3 years) and 14 older adults (3 males and 11 females; age 69 ± 4 years) while walking on a taped line on the floor and a 6-cm wide beam. Spatiotemporal parameters of gait, margin of stability, motor performance, and muscle synergies were estimated. Regardless of age, maintaining walking balance was more difficult on the beam compared to the taped line as evidenced by a shorter distance walked (17.3%), a reduction in step length (5.8%) and speed (10.3%), as well as a 40.0% smaller margin of stability during beam vs. tape walking. The number of muscle synergies was also higher during beam vs. tape walking. Compared to younger adults, older adults had larger margin of stability during beam walking. Older adults also had higher muscle co-activity within each muscle synergy and greater variance accounted for by the first muscle synergy regardless of condition. Such age-effects may be interpreted as a safer, less efficient, and less complex neuromuscular modular control strategy. In conclusion, beam walking increased the difficulty of maintaining walking balance and induced adaptations in modular control. It seems that healthy older adults reduce the complexity and efficiency of neuromuscular control of walking to preserve walking balance.

Associations between Age-Related Changes in the Core Vestibular Projection Pathway and Balance Ability: A Diffusion Tensor Imaging Study

Objective

We investigated the changes of the vestibulospinal tract (VST) and parietoinsular vestibular cortex (PIVC) using diffusion tensor imaging (DTI) and relation to balance between old and young healthy adults.

Methods

This study recruited eleven old adults (6 males, 5 females; mean age 63.36 ± 4.25 years) and 12 young adults (7 males, 5 females; mean age 28.42 ± 4.40 years). The lateral and medial VST and PIVC were reconstructed using DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The six-minute walk test (6-MWT), the timed up and go test (TUG), and the Berg balance scale (BBS) were conducted. Spatiotemporal parameters during tandem gait and values of sway during one-leg standing using the wearable sensors were measured. All parameters between two groups were analyzed by the Mann-Whitney U test and independent t-test.

Results

Statistically significant decrease in old adults was detected in the tract volume of lateral (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (.

Conclusion

The results suggested that there was a relationship between DTI parameters in the vestibular neural pathway and balance according to aging.

Effects of the Use of Anchor Systems in the Rehabilitation of Dynamic Balance and Gait in Individuals With Chronic Dizziness of Peripheral Vestibular Origin: A Single-Blinded, Randomized, Controlled Clinical Trial

OBJECTIVE

To assess the effectiveness of the anchors in the balance rehabilitation of participants with chronic peripheral vestibulopathy who failed to respond positively to conventional rehabilitation for dynamic balance and gait.

DESIGN

Assessor-blind, randomized controlled trial.

SETTING

Department of Otoneurology and Laboratory of Assessment and Rehabilitation of Equilibrium.

PARTICIPANTS

Women with chronic dizziness of peripheral vestibular origin (N=42), who continued to show otoneurologic symptoms for more than 6 months after starting classic vestibular rehabilitation, with no clinical improvement observed.

INTERVENTIONS

Participants were randomly assigned to receive a clinical intervention with the anchor system, a clinical intervention without the anchor system, or no intervention or anchor system. The intervention was based on multi-sensory exercises for 6 weeks, twice a week, totaling 12 sessions, in groups of up to 4 participants, with an average time of 40 minutes per session.

MAIN OUTCOME MEASURES

The primary outcome was functional balance as assessed by the short version of the Balance Evaluation Systems Test. The secondary outcomes were gait parameters of step width in meters, step length in meters, and gait speed in meters per second. The measures were assessed preintervention and postintervention, and after a 3-month follow-up period.

RESULTS

The proposed intervention was beneficial for dizziness, balance, and gait for both groups studied. At the 3-month follow-up, only the group that used anchors retained the benefits related to the physical aspects of dizziness, balance, and gait.

CONCLUSIONS

The present study found that the proposed intervention protocol, with or without the use of anchors, was beneficial for improving the dizziness, balance, and gait. However, retention of the benefits achieved through the exercise protocol was observed only for those using the anchor system, which promotes the use of haptic information. The use of anchors was effective, in short protocols (12wk), with maintenance of results after 3 months.

Are there attentional demands associated with haptic modalities while walking in young, healthy adults?

STUDY DESIGN

A prospective, observational study.

OBJECTIVES

To assess the attentional demands of using haptic modalities during walking using a multi-task paradigm in young, healthy adults.

SETTING

Biomechanics of Balance and Movement (BBAM) Lab, University of Saskatchewan.

METHODS

Twenty-two (12 male) young, healthy adults performed walking trials with and without a verbal reaction time (VRT) task, as well as with and without the use of haptic anchors and light touch on a railing. Walking performance was evaluated using normalized stride velocity and step width, and dynamic stability was evaluated using step width variability and medial-lateral margin of stability (ML MOS) and its variability.

RESULTS

There were no significant differences in VRT when walking with and without added haptic input and no interactions between the added VRT task and added haptic input. Step width increased and variability of the ML MOS increased during trials with the VRT task compared to trials without the VRT task. The ML MOS decreased when using both haptic tools with a greater decrease when using light touch on the railing compared to when using the haptic anchors. Normalized stride velocity and step width decreased when using light touch on the railing only.

CONCLUSION

Both haptic tools affected stability during walking. Using the railing to add haptic input had a greater effect on walking stability and was the only haptic tool to affect walking performance. Attentional demands should be considered in future research and applications of adding haptic input during walking.

Beam Walking to Assess Dynamic Balance in Health and Disease: A Protocol for the "BEAM" Multicenter Observational Study

BACKGROUND

Dynamic balance keeps the vertical projection of the center of mass within the base of support while walking. Dynamic balance tests are used to predict the risks of falls and eventual falls. The psychometric properties of most dynamic balance tests are unsatisfactory and do not comprise an actual loss of balance while walking.

OBJECTIVES

Using beam walking distance as a measure of dynamic balance, the BEAM consortium will determine the psychometric properties, lifespan and patient reference values, the relationship with selected "dynamic balance tests," and the accuracy of beam walking distance to predict falls.

METHODS

This cross-sectional observational study will examine healthy adults in 7 decades (n = 432) at 4 centers. Center 5 will examine patients (n = 100) diagnosed with Parkinson's disease, multiple sclerosis, stroke, and balance disorders. In test 1, all participants will be measured for demographics, medical history, muscle strength, gait, static balance, dynamic balance using beam walking under single (beam walking only) and dual task conditions (beam walking while concurrently performing an arithmetic task), and several cognitive functions. Patients and healthy participants age 50 years or older will be additionally measured for fear of falling, history of falls, miniBESTest, functional reach on a force platform, timed up and go, and reactive balance. All participants age 50 years or older will be recalled to report fear of falling and fall history 6 and 12 months after test 1. In test 2, seven to ten days after test 1, healthy young adults and age 50 years or older (n = 40) will be retested for reliability of beam walking performance.

CONCLUSION

We expect to find that beam walking performance vis-à-vis the traditionally used balance outcomes predicts more accurately fall risks and falls.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03532984.

Additional Haptic Information Provided by Anchors Reduces Postural Sway in Young Adults Less Than Does Light Touch

This study investigated the effect of adding haptic information to the control of posture, as well as comparing the effect of both the “light touch” (LT) and “anchor system” (AS) paradigms on postural sway. Additionally, it compared the effect of location and number of points of contact to the control of posture in young adults. The location consisted of using the anchors tied to the finger and held by the hands, and, for LT, the fingertip. For the number of points of contact, participants used two hands, and then separately the dominant hand, and the non-dominant hand, for both anchor and LT paradigms. Participants stood upright with feet-together and in tandem position while performing tasks that combined the use of anchors and LT, points of contact (hand grip and finger), and number of points of contact (two hands and one hand). In this study, the anchors consist of holding in each hand a flexible cable with the other end attached to the ground. The LT consists of slightly touching a rigid surface with the tip of the index finger. The results showed, first, that the anchors improved postural control less than did the LT. Second, they revealed that holding the anchors with the hands or with them tied to the fingertip resulted in a similar reduction in postural sway only in the tandem position. For the feet-together position, the anchors tied to the fingertip were ineffective. Similarly, the use of one or two hands did not affect the contribution of the anchors. However, using two hands in the LT condition was more effective than was one hand. Third, our results showed the presence of a temporal delay between force and center-of-pressure (COP) for the anchors, only in the AP direction with feet-together. In conclusion, overall, the anchors were less effective in reducing postural sway than was the LT. The anchors attached to fingertips were as effective as the hand-held anchors in the tandem position, yet ineffective during foot-together standing. Force-COP timing explains reduced postural sway with LT but not for the anchor; hence, exploratory and supra-postural components may be involved.